2023 Metabolites

Consuming bicarbonate-calcium mineral water, low in sodium, can help manage calcium imbalance and support bone health in perimenopausal women.

The study involved 120 perimenopausal women who consumed 2 liters of a specific bicarbonate-calcium mineral water (Lete) daily for six months. This water was chosen because it is rich in calcium and bicarbonate but low in sodium. The study aimed to determine the impact of this water on bone health and overall metabolism. The participants’ urine and blood serum were analyzed using NMR-based metabolomic procedures. These analyses were conducted to assess the effects of the water not only on calcium metabolism but also on the broader systemic metabolism.

The findings indicated that the Lete water effectively compensated for calcium dysmetabolism and supported bone health and integrity in perimenopausal women. While the study primarily focused on bone metabolism, it also provided insights into the potential system-wide metabolic effects of this specific type of mineral water. This suggests that such water could be a valuable dietary supplement for addressing calcium-related metabolic issues, particularly in perimenopausal women.

Supplementing Low-Sodium Bicarbonate–Calcic (Lete)® Water: Effects in Women on Bone and Systemic Metabolism Marino C, Pagano I, Castaldo G, Grimaldi M, D’Elia M, Santoro A, Conte A, Molettieri P, Parisella C, Buonocore M, D’Ursi AM, Rastrelli L

2023 Food Research International

Fermented soy milk significantly improves lipid profiles and fertility in a model of premenopausal mice, due to increased bioavailability and action of beneficial compounds.

In this study, non-fermented soy beverage (SB) and soy beverage fermented with Bifidobacterium pseudocatenulatum INIA P815 (FSB) were tested on both cyclic and acyclic C57BL/6J aged female mice which mimic premenopause and menopause conditions respectively. Over a period of 36 days, the beverages were given to the mice and the variables measured included body weight, lipid and inflammatory profile and fertility. In addition, hepatic gene expressions were examined and the faecal microbiota composition was assessed to further understand the effects of the two beverages.

In the results, FSB displayed a higher concentration of the aglycones daidzein and genistein as well as increased antioxidant activity due to the fermentation process. The cyclic mice that were given FSB experienced a significant rise in the number of oocytes and zygotes retrieved. It was also noticed that the triglycerides were lower in the groups that were given FSB compared to the SB groups. However, it was found that neither of the treatments significantly influenced the inflammatory profile or caused a major shift in intestinal microbiota or hepatic gene expressions in either of the groups. Still, it was observed that FSB had more health benefits than SB with regards to the lipid profile and fertility in the cyclic mice, likely due to the increased bioavailability and bioactivity of compounds due to fermentation.

Effect of fermented soy beverage in aged female mice model Ruiz de la Bastida A, Langa S, Peirotén , Fernández-Gonzalez R, Sánchez-Jiménez A, Maroto M, Antonio Curiel J, Guillamon E, Arqués JL, Gutiérrez-Adán A, Landete JM

2023 Phytotherapy Research

Pomegranate can significantly enhance women's health during and after menopause by reducing hot flashes severity and other menopause symptoms.

The study aimed at understanding the impacts of pomegranate on women's health through and following menopause. To gather data, a rigorous search was conducted on various academic platforms, including PubMed, Web of Science, Cochrane, Scopus, and Google Scholar, up to the end of 2022. All forms of clinical research studies, from randomized clinical trials to case series, were considered for review. The material was evaluated using the Cochrane RoB 2.0 tool specifically for quality assessment of randomized clinical trials. To quantify the effects of the pomegranate intervention, standardized mean differences were calculated using a random effect model.

It was found that pomegranate significantly reduces the severity of hot flashes in menopausal women, improves their high-density lipoprotein levels, and reduces the Follicle-Stimulating Hormone (FSH). However, no significant improvement was noticed in the low-density lipoprotein, body mass index, and body weight. Despite these findings, the study recognized that the results' conclusiveness was hampered due to small sample sizes and the lack of study design elements such as blinding and randomization.

Pomegranate effects on the health aspects of women during peri‐ and postmenopause: A systematic review and meta‐analysis Moeini R, Shirafkan H, Gorji N

2023 Modern Care Journal

Saffron shows promising improvements in dealing with women's health issues related to labor, childbirth, premenstrual syndrome and menopause.

For the methodology, the investigators implemented a systematic review by utilizing the PICO process to explore various databases like PubMed, Scopus, Cochrane, among others, until February 2023. A strategically designed search was conducted using a set of keywords related to saffron and women's health conditions. From a pool of 164 articles, 20 randomized controlled trials that met the minimum score based on the Jadad scale were included in the study.

In terms of results, the investigation revealed that saffron holds positive impacts on labor and childbirth, such as enhancing Bishop's score, fostering labor progression, and reducing labor pain intensity and fatigue. Moreover, it helps with episiotomy healing and ameliorates mood swings and psychological symptoms associated with menopause and premenstrual syndrome. The study also acknowledges some influence of saffron on postpartum depression.

Efficacy of Saffron (Crocus sativus L.) in Premenstrual Syndrome, Labor, Childbirth, and Menopause: A Systematic Review of Clinical Trials Irani M, Rahmanian A, Soltani N

2022 Medicine

High prevalence of insomnia, anxiety, and depression among perimenopausal women, emphasizing the importance of exploring acupuncture as a potential green therapy for effectively addressing these interconnected issues.

This passage discusses the prevalence of insomnia among perimenopausal women, its association with anxiety and depression, and the potential of acupuncture as a green therapy for treating these issues. The passage outlines the objectives and methods of a systematic review aiming to evaluate the efficacy of acupuncture in improving sleep quality and alleviating anxiety and depression in perimenopausal women, highlighting the need for safer alternatives to conventional medications and the significance of such a study.

Can acupuncture improve sleep quality and anxiety among women during perimenopause? Ping Y, Liang C, Fan X, Zhang L, Ying D, Wang Z

2022 Menopause

A diet low in fat, vegan, and inclusive of daily cooked soybeans significantly reduces the frequency and severity of hot flashes in postmenopausal women.

The methodology used involved the selection of 84 postmenopausal women who reported at least two moderate-to-severe hot flashes. These women were randomly divided into two cohorts, one prescribed the dietary intervention of a low-fat, vegan diet coupled with daily servings of cooked soybeans and a control group which did not alter their diet. Over a 12-week period, a mobile application was used to track hot flashes in terms of frequency and severity. Further, the participants’ vasomotor, psychosocial, physical, and sexual symptoms were assessed using the Menopause-Specific Quality of Life questionnaire. In some participants, the presence of urinary equol, a compound formed in the gut after consuming soy, was measured following the intake of the specified amount of soybeans for 3 days.

In discussing the results, a remarkable decrease was noted in the frequency and severity of hot flashes experienced by the group assigned the dietary intervention versus those in the control group. In addition, after 12 weeks, half of the participants adhering to the vegan diet and daily soy intake reported complete cessation of moderate-to-severe hot flashes. Furthermore, notable decreases were reported in the intervention group in menopause-specific quality of life domains including vasomotor, physical, and sexual. Neither the season nor the participant's ability to produce equol played a notable role in these improvements.

A dietary intervention for vasomotor symptoms of menopause: a randomized, controlled trial Barnard ND, Kahleova H, Holtz DN, Znayenko-Miller T, Sutton M, Holubkov R, Zhao X, Galandi S, Setchell KDR

2021 Molecules

In reproductive health, honey can improve infertility, protect the postmenopausal reproductive tract, prevent toxic effects, maintain sperm quality by restoring testosterone levels and treat vulvovaginal candidiasis infections.

Honey has a highly complex chemical and biological composition that consists of various essential bioactive compounds, enzymes, amino and organic acids, acid phosphorylase, phytochemicals, carotenoid-like substances, vitamins and minerals. Reproductive health and fertility rates have declined in the last 30 years. Therefore, this review aimed to highlight the protective role of honey as a potential therapeutic in maintaining reproductive health.

The main role of honey is to enhance fertility and treat infertility problems by acting as an alternative to hormone replacement therapy for protecting the vagina and uterus from atrophy, protecting against the toxic effects of xeno-oestrogenic agents on female reproductive functions and helping in the treatment of gynaecological disorders, such as vulvovaginal candidiasis infection, that affect women’s lives.

Protective Roles of Honey in Reproductive Health: A Review Zaid SSM, Ruslee SS, Mokhtar MH

2021 Complementary Therapies in Medicine

The Licorice and Jujube formula is seen as commonly used and potentially effective for treating menopausal symptoms as per classical Chinese medicine.

The methodology of this study involved exploring classical Chinese medicine textbooks to find the most frequent herbal mix used for symptoms similar to menopause. The approach taken was to sort and identify the formulas from the Encyclopedia of Traditional Chinese Medicine, a comprehensive resource in this field. Following this, a thorough review of randomized controlled trials was performed in order to determine the efficacy of the most common formula.

In terms of results, it was discovered that the Licorice and Jujube formula (LJF) was the most commonly found, mentioned in 36% of the analyzed references. The review of controlled trials revealed that the LJF might be effectively utilized for the improvement of sleep-related symptoms. Additionally, experimental studies hinted at potential benefits of the LJF, including sedative, antidepressant-like, estrogenic, and antiprogestogenic effects.

Licorice (Glycyrrhiza spp.) and jujube (Ziziphus jujuba Mill.) formula for menopausal symptoms: Classical records, clinical evidence and experimental data Coyle ME, Liu J, Yang H, Wang K, Zhang AL, Guo X, Lu C, Xue CC

2021 European Journal of Obstetrics & Gynecology and Reproductive Biology

Phytoestrogens, used in various forms, have shown improvement in urogenital menopause symptoms and improved women's sexual function, promoting overall quality of life.

A thorough and systematic review was conducted on databases including PubMed, EMBASE, Web of Science, Cochrane library, Scopus and ProQuest, spanning from the years 2000-2020. The focus was solely on randomized clinical trials. An evaluation of the quality of selected papers was carried out using the CONSORT checklist. In total, 33 high-quality papers were reviewed which discussed the different forms and uses of phytoestrogens.

The results of this systematic review reveal that phytoestrogens including Pueraria Mirifica, fennel, Hop plant, Glycine Max, soy, red clover, black cohosh, ginsing, cimicifugaracemosa, genistein, diadzein, glycitein and isoflavone, used as various products such as oral capsules, pills, food supplements, enriched powders, vaginal gels, creams and suppositories, improved menopausal urogenital symptoms. Particularly, the recovery rate was found to be higher when these were applied vaginally. Further implication of these findings is the enhancement of women's sexual function following treatment, validating the use of phytoestrogens as a safe, low-risk and accessible method to alleviate urogenital symptoms.

Impact of phytoestrogens on treatment of urogenital menopause symptoms: A systematic review of randomized clinical trials Abdi F, Rahnemaei FA, Roozbeh N, Pakzad R

2021 Nutrients

Moderate daily consumption of beer, both with and without alcohol, can significantly alleviate menopause-related symptoms and improve cardiovascular health in postmenopausal women.

In the research, 37 postmenopausal women were voluntarily put through a parallel controlled intervention trial, involving three study groups. The trial involved 16 women consuming beer with alcohol (330 mL/day), 7 women consuming non-alcoholic beer (660 mL/day), and 14 women as control.

In assessing the results, it was found that both interventions, beer with and without alcohol, substantially reduced the severity of menopause-associated symptoms. Specifically, beer with alcohol positively contributed to reducing psychological discomforts linked to menopause when compared to the control group. It was additionally noted that these beneficial effects could be traced to the non-alcoholic section of the beer, as the sex hormone profile remained largely unchanged across the different study groups. In addition, the group that consumed non-alcoholic beer conveyed improvements in their lipid profiles and exhibited lower blood pressure levels, indicating better cardiovascular health.

Moderate Consumption of Beer (with and without Ethanol) and Menopausal Symptoms: Results from a Parallel Clinical Trial in Postmenopausal Women Trius-Soler M, Marhuenda-Muñoz M, Laveriano-Santos EP, Martínez-Huélamo M, Sasot G, Storniolo CE, Estruch R, Lamuela-Raventós RM, Tresserra-Rimbau A

2019 Biomedicines

Guizhi Fuling Wan, a traditional herbal formula, can improve peripheral blood flow in menopausal hot flush sufferers, despite not changing the frequency or severity of the flushes.

The methodology used in this study involved a comprehensive literature search across 20 English and Chinese databases for relative clinical and experimental studies. From the nearly 13,000 studies identified, only 46 were evaluated as relevant and thus included in the review. These articles were comprised of seven clinical studies detailing Guizhi Fuling Wan's effects on menopausal hot flushes and 35 phytochemical analysis studies that identified the 169 chemical compounds in the herbal formula. Four experimental studies were also utilized to discover the potential therapeutic effects and target proteins/cytokines related to these hot flushes.

The findings indicate that Guizhi Fuling Wan, despite exhibiting no significant impact on the frequency or severity of menopausal hot flushes, may have positive effects on peripheral blood flow. The blood flow improvements were specifically noted in the fingertips, jaw, and toes. Additionally, the analysis of the herbal formula revealed 169 distinct chemical compounds. Through experimental studies, potential therapeutic effects on target proteins/cytokines - including estrogen receptor beta with genetic variation, the calcitonin gene-related peptide receptor, and interleukin-8, were further highlighted. However, these therapeutic effects were inconsistent across different studies, which may be due to dosage differences and genotype variation.

A Classic Herbal Formula Guizhi Fuling Wan for Menopausal Hot Flushes: From Experimental Findings to Clinical Applications Li , Hung , Li , Yang

2019 Biomedicines

Guizhi Fuling Wan, a traditional herbal formula, can improve peripheral blood flow in menopausal hot flush sufferers, despite not changing the frequency or severity of the flushes.

The methodology used in this study involved a comprehensive literature search across 20 English and Chinese databases for relative clinical and experimental studies. From the nearly 13,000 studies identified, only 46 were evaluated as relevant and thus included in the review. These articles were comprised of seven clinical studies detailing Guizhi Fuling Wan's effects on menopausal hot flushes and 35 phytochemical analysis studies that identified the 169 chemical compounds in the herbal formula. Four experimental studies were also utilized to discover the potential therapeutic effects and target proteins/cytokines related to these hot flushes.

The findings indicate that Guizhi Fuling Wan, despite exhibiting no significant impact on the frequency or severity of menopausal hot flushes, may have positive effects on peripheral blood flow. The blood flow improvements were specifically noted in the fingertips, jaw, and toes. Additionally, the analysis of the herbal formula revealed 169 distinct chemical compounds. Through experimental studies, potential therapeutic effects on target proteins/cytokines - including estrogen receptor beta with genetic variation, the calcitonin gene-related peptide receptor, and interleukin-8, were further highlighted. However, these therapeutic effects were inconsistent across different studies, which may be due to dosage differences and genotype variation.

A Classic Herbal Formula Guizhi Fuling Wan for Menopausal Hot Flushes: From Experimental Findings to Clinical Applications Li , Hung , Li , Yang

2017 PLOS One

Acupuncture is non-inferior to hormone therapy or other applied relaxation therapies in alleviating the symptoms of menopause for its safety, non-invasive and especially considering the side effect of hormone therapy.

This meta-analysis of women with breast cancer confirms that acupuncture had no significant effect on the severity of hot flush, but did significantly alleviate the symptoms of menopause. We conclude that acupuncture is non-inferior to hormone therapy or other applied relaxation therapies in alleviating the symptoms of menopause for its safety, non-invasive and especially considering the side effect of hormone therapy. Recent studies show that use of acupuncture does not correlate with increased levels of plasma estradiol. Considering the safety and lack of serious adverse effects associated with acupuncture, in contrast to hormone therapy, acupuncture should be considered for treating hot flush and menopause syndrome in women with breast cancer.

Effect of acupuncture on hot flush and menopause symptoms in breast cancer- A systematic review and meta-analysis Chien TJ, Hsu CH, Liu CY, Fang CJ.

2017 Complementary Medicine Research

Both the total score and the subgroup analysis strongly indicated that acupuncture can alleviate menopause-related symptoms.

Six studies were included. Our analysis found that acupuncture can reduce the MRS score in menopausal women by the end of the treating period (2-3 months, on average) and even in the follow-up period (1-3 months), not only in the total score but also in each subscale score. But the grade of evidence is very low.

Both the total score and the subgroup analysis strongly indicated that acupuncture can alleviate menopause-related symptoms. However, the evidence is not very strong. Thus, further studies about the efficiency of acupuncture on menopausal symptoms based on well-designed trials are needed.

Acupuncture May Improve Quality of Life in Menopausal Women: A Meta-Analysis of Randomized Controlled Trials Li W, Luo Y, Fu W, Lei R.

2017 Oxidative Medicine and Cellular Longevity

Moderate beer consumption could potentially alleviate menopausal symptoms by influencing the internal estrogen receptors through the phenolic compounds present in beer.

The study used the developments in food analysis techniques over the past two decades to explore the correlation between the intake of polyphenols from moderate beer consumption and the relief of vasomotor symptoms often experienced during menopause. The focus was on phenolic compounds present in beer like 8-prenylnaringenin, 6-prenylnaringenin, and isoxanthohumol and how they interact directly with intracellular estrogen receptors to influence gene expression and sex hormone plasma concentrations.

The observed results pointed to the potential positive effects of moderate beer consumption on menopausal symptoms. It was inferred that phenolic compounds in beer could interact directly with intracellular estrogen receptors, leading to a modulation of gene expression, thereby balancing physiological hormone imbalance in menopausal women. This alternative could serve as a safer option for alleviating menopausal symptoms as traditional hormone replacement therapies have known health risks. However, these findings need to be viewed keeping in mind the implications of beer consumption on overall health.

Beer Polyphenols and Menopause: Effects and Mechanisms—A Review of Current Knowledge Sandoval-Ramírez BA, Lamuela-Raventós RM, Estruch R, Sasot G, Doménech M, Tresserra-Rimbau A

2016 Revista Latino-Americana de Enfermagem

The study's analysis of 272 articles comparing Traditional Chinese Acupuncture (TCA) and Sham Acupuncture (SA) for managing hot flashes in menopausal breast cancer patients indicates that while 3 studies leaned towards TCA's effectiveness, 2 showed both interventions to be beneficial.

The study encompassed the analysis of 272 articles from five selected databases, resulting in the inclusion of five manuscripts meeting the eligibility criteria. The primary focus was on comparing the efficacy of Traditional Chinese Acupuncture (TCA) to Sham Acupuncture (SA) in managing hot flashes among menopausal women with breast cancer. Among the selected studies, three indicated that TCA was more effective in reducing the frequency and intensity of hot flashes, while two found both interventions to be beneficial, though not significantly distinct. These studies exhibited considerable diversity in their designs, sample sizes, treatment durations, and acupuncture protocols. TCA appeared to hold promise in mitigating hot flashes, yet several methodological limitations and potential biases within the reviewed studies were noted. Consequently, there's a call for further comprehensive, large-scale, and long-term trials to elucidate TCA's true potential and overcome the limitations observed in the current body of research.

Effectiveness of Traditional Chinese Acupuncture versus Sham Acupuncture: a Systematic Review Carlos, Luís et al.

2013 Neuropediatrics

Hop extract, particularly its component 8-Prenylnaringenin (8-PN), demonstrates potential in alleviating symptoms common in menopause such as osteoporosis, vasomotoric disturbances, and sexual motivation.

The methodology of this research involved identifying the major constituents of hop extract, with a focus on 8-Prenylnaringenin (8-PN) due to its estrogenic qualities. Several in vivo studies were conducted to explore the potential of hop extract and 8-PN in mitigating climacteric symptoms. Clinical studies conducted have mainly centered around menopausal discomforts, still, these studies provided broad results.

In the discussion of the results, it was found that hop extract, and more prominently, 8-PN, show promise in alleviating menopausal symptoms such as osteoporosis, vasomotoric issues, and sexual desire. Although 8-PN primarily activates the estrogen receptor α and presents only slight uterotrophic attributes, it also brings about estrogenic effects on the mammary gland. The results indicate potential application of 8-PN and hop extract in alleviating symptoms commonly associated with menopause.

Hop Extracts and Hop Substances in Treatment of Menopausal Complaints Keiler A, Zierau O, Kretzschmar G

2013 Neuropediatrics

Hop extract, particularly its component 8-Prenylnaringenin (8-PN), demonstrates potential in alleviating symptoms common in menopause such as osteoporosis, vasomotoric disturbances, and sexual motivation.

The methodology of this research involved identifying the major constituents of hop extract, with a focus on 8-Prenylnaringenin (8-PN) due to its estrogenic qualities. Several in vivo studies were conducted to explore the potential of hop extract and 8-PN in mitigating climacteric symptoms. Clinical studies conducted have mainly centered around menopausal discomforts, still, these studies provided broad results.

In the discussion of the results, it was found that hop extract, and more prominently, 8-PN, show promise in alleviating menopausal symptoms such as osteoporosis, vasomotoric issues, and sexual desire. Although 8-PN primarily activates the estrogen receptor α and presents only slight uterotrophic attributes, it also brings about estrogenic effects on the mammary gland. The results indicate potential application of 8-PN and hop extract in alleviating symptoms commonly associated with menopause.

Hop Extracts and Hop Substances in Treatment of Menopausal Complaints Keiler A, Zierau O, Kretzschmar G

2011 Climacteric

Pumpkin seed oil supplementation may increase good cholesterol levels, lower diastolic blood pressure, and alleviate menopausal symptoms in postmenopausal women.

In this pilot study employing a randomized, double-blinded and placebo-controlled design, 35 women that were either naturally menopausal or had prematurely entered menopause due to benign surgical intervention partook. Over the span of 12 weeks, participants received either pumpkin seed oil or wheat germ oil (serving as the placebo) at a dosage of 2 grams daily. Measurements of serum lipids, fasting plasma glucose, blood pressure and completion of a questionnaire regarding menopausal symptoms were taken before and after the supplementation period, and changes across these factors were evaluated.

Following supplementation, women who received pumpkin seed oil displayed increased concentrations of high density lipoprotein cholesterol (commonly known as good cholesterol) and a reduction in diastolic blood pressure. Additionally, there was a notable decline in the severity of menopausal symptoms, including hot flushes, headaches, and joint pain, thanks to this supplementation. Contrarily, symptoms of depression and feelings of being unloved heightened among women in the group that received wheat germ oil.

Improvement in HDL cholesterol in postmenopausal women supplemented with pumpkin seed oil: pilot study Gossell-Williams M, Hyde C, Hunter T, Simms-Stewart D, Fletcher H, McGrowder D, Walters CA

2011 Journal of Acupuncture and Meridian Studies

Gui-zhi-fu-ling-wan, a traditional Chinese medicine, can effectively alleviate hot flashes in young patients in a safe manner.

For the methodology, this study was conducted retrospectively, examining the medical records of patients who visited the Department of Cardiovascular and Neurologic Disease, Kyung Hee Oriental Medical Center for hot flashes from between October 1, 2003, to October 1, 2008. Out of 60 cases reviewed, 37 were selected based on the inclusion criteria. The primary measure of improvement was assessed using the visual analog scale.

In the discussion of results, it was noted that the mean improvement in symptoms was significant and a majority of patients experienced a 50% improvement. The secondary analysis revealed that the outcomes of differential diagnosis of cold and hot syndrome and blood stasis syndrome did not affect the scores. Importantly, only a trivial percentage of patients reported adverse events, indicating that Gui-zhi-fu-ling-wan may be a safe therapy for hot flashes.

Effect of Gui-zhi-fu-ling-wan on Hot Flashes in Young Patients: A Retrospective Case Series Cho KH, Kim YS, Jung WS, Kim TH

2005 The American Journal of Chinese Medicine

Gui-zhi-fu-ling-wan, a herbal therapy, depicts to be a viable alternative to hormone replacement therapy for treating hot flashes in post-menopausal women experiencing coldness in lower extremities.

In this study, an examination of the connection between extremities' blood flow and hot flashes was conducted among 352 post-menopausal women aged between 46 and 58 who were showing climacteric complaints. 131 of these women, who were experiencing hot flashes, were treated either with HRT or Gui-zhi-fu-ling-wan, a type of herbal therapy. This investigation measured blood flow under the jaw, in the middle finger, and the third toe using laser doppler fluxmetry.

Subsequent to the therapies, there was a notable decrease in the heightened blood flow under the jaw that is associated with hot flashes. However, the herbal therapy, Gui-zhi-fu-ling-wan, interestingly, increased blood flow in the lower extremities while the hormone replacement therapy did not. This suggests that Gui-zhi-fu-ling-wan does not uniformly affect the activity of the vasodilator neuropeptides on the sensory neurons of systemic peripheral vessels, thereby proving more effective in treating hot flashes accompanied with cold lower extremities.

Comparing the Effects of Estrogen and an Herbal Medicine on Peripheral Blood Flow in Post-menopausal Women with Hot Flashes: Hormone Replacement Therapy and Gui-Zhi-Fu-Ling-Wan, a Kampo Medicine Ushiroyama T, Ikeda A, Sakuma K, Ueki M