Retroviral transfer of herpes simplex thymidine kinase gene into glioma cells causes targeting of gancyclovir cytotoxic effect

The thymidine kinase (tk) gene of herpes simplex virus type 1 (HSV-1) was transduced into three glioma cell lines (T98, U251MG, T9) using a retrovirus vector. The supernatants of viral producer cell line PA317/LTRNL was used for infection and three transduced cell lines (T98/LTRNL, U251MG/LTRNL, T9/LTRNL) were established. The toxicities of the anti-herpetic drugs, acyclovir and gancyclovir, were evaluated in vitro. The cytotoxicities of acyclovir and gancyclovir to the HSV-1 tk gene-transduced cells increased 100-1000 fold compared to the non-transduced parental cell lines. The cytotoxic effect of gancyclovir was higher than that of acyclovir, requiring a concentration of less than 0.31 microM to obtain 50% inhibition. Deoxyribonucleic acid analysis of the gancyclovir-treated cells demonstrated fragmentation, suggesting that apoptosis is involved in the mechanism of cell death. The HSV-1 tk gene-transduced cells were co-cultured with parental cells and treated with gancyclovir. More than 95% of cells were killed in a mixture ratio of 1:1, suggesting that the "bystander effect" operated in this system. Selective transduction of HSV-1 tk gene into glioma cells using a retroviral vector and treatment with gancyclovir is a promising therapy for patients with malignant glioma.

Differences in immunomodulating effects between wild and cultured Panax ginseng

The different effects between wild and cultured Panax ginseng on immunological activity were investigated. The extracts of hot water soluble fraction from wild Panax ginseng showed the mitogenic activity to lymphocytes but that from cultured Panax ginseng did not. The mitogenic activity of wild Panax ginseng (100 micrograms/well) was almost equal to Concanavalin A (0.1 microgram/well) which was well-known as one of T cell mitogens. The percentages of Thy 1.2-(pan T cells), L3T4-(helper T cells) and Lyt2-(cytotoxic T cells) positive cell population were significantly increased in the mice orally administered hot water soluble fraction from wild Panax ginseng as compared to control by 31.2, 17.9 and 30.1 percent, respectively.

Chronic hepatitis C complicated by Coombs-negative hemolytic anemia during interferon treatment

Autoimmune hemolytic anemia is an autoimmune diseases which is reported to be caused by interferon treatment. A 33-year-old male with chronic hepatitis C developed Coombs-negative hemolytic anemia, probably due to administration of interferon-alpha 2b. This is, to our knowledge, the first report of chronic hepatitis C complicated by Coombs-negative hemolytic anemia during interferon treatment.

A possible role for stable microtubules in intracellular transport from the endoplasmic reticulum to the Golgi apparatus

The intracellular transport of secretory proteins involves at an early stage the formation of vesicles from transitional elements of the endoplasmic reticulum (ER) containing these proteins and the transfer of these vesicles to the cis-face of the Golgi apparatus. We propose that the latter transfer process does not occur by random diffusion, but is instead mediated by tracking along stable microtubules. To test this proposal, we have carried out double immunoelectron microscopic labeling experiments on frozen sections of HepG2 hepatoma cells secreting the protein human serum albumin (HSA). By a cycloheximide treatment protocol, the stage during which the transfer of newly synthesized HSA from the ER to the Golgi apparatus occurs in vivo was determined. Sections of the cells were then double immunolabeled using primary antibodies to HSA and to glu-tubulin, the latter specifically detecting stable microtubules. We observed a significantly high frequency of HSA-containing structures between the ER and the Golgi apparatus with which stable microtubules were closely associated. These results support the proposal that stable microtubules may play a critical role in directing the transfer process from the ER to the Golgi apparatus.

Functions of macrophages in human decidual tissue in early pregnancy

PROBLEM

Roles of decidual macrophages (DMs) in the maintenance of early pregnancy was determined by comparing three of their functions, antigen presentation, immunoregulation, and lymphokine production, with those of peripheral monocytes (PMos) isolated from the same subjects.

METHOD

The antigen-presenting capacity of DMs was examined by the one-way mixed lymphocyte reaction (MLR) in which accessory cell-depleted mononuclear cells isolated from pregnant women were used as responders. The effect of DMs on cellular immunity was investigated by inhibition tests of either one-way MLR or phytohemagglutinin stimulation. The production of interleukin-1 (IL-1) and prostaglandin E2 (PGE2) by DMs following lipopolysaccharide stimulation was examined.

RESULTS

Addition of increasing concentrations of DMs to the culture resulted in a concentration-dependent proliferative response, as well as with PMos. In both assays, a stronger suppression was observed in the presence of DMs from normal pregnant women compared with PMos from the same subjects. DMs were found to secrete significantly lower levels of IL-1 alpha and IL-1 beta than PMos. No difference in PGE2 production was observed between DMs and PMos.

CONCLUSIONS

These findings suggest that DMs present in human early decidual tissue have a capacity for allo-antigen presentation, a higher suppressive activity, and a lower capacity to produce IL-1 than their peripheral counterparts.

Normal and neoplastic mammary gland growth in MMTV/TGF alpha transgenic mice

Biochemical and Dynamic change of mammary glands in different reproductive states were studied in comparison with histological structures in female and male transgenic mice bearing human transforming growth factor alpha (TGF alpha) cDNA under the control of the mouse mammary tumour virus enhancer/promoter. Female and male F1 mice between SHN female and transgenic male mice were divided into TGF alpha (+) and TGF alpha (-) groups according to the presence of TGF alpha gene at approximately 50 days of age. While there was little difference in mammary gland contents of DNA and RNA in females at 2 months of age, both nucleic acid contents were elevated markedly in TGF alpha (+) female mice with large variations at 4 months. These extremely high DNA and RNA contents in the TGF alpha (+) group declined to the level of the TGF alpha (-) group in the middle of pregnancy and at the end of pregnancy, respectively. Thymidine kinase (TK) activity in the mammary glands as an index of DNA synthesis was significantly higher in TGF alpha (+) mice than in TGF alpha (-) mice at both 2 and 4 months of age and the high TK in TGF alpha (+) mice also declined to the level of TGF alpha (-) mice with pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of alpha-lipoic acid and dihydrolipoic acid on expression of proto-oncogene c-fos

The transcription factor AP-1 is an important human mediator of the cellular response to serum, growth factors, and phorbol esters such as 12-O-tetradecanoyl-phorbol-13 acetate (TPA). The AP-1 complex consists of distinct protein heterodimers encoded by the proto-oncogene c-fos and c-jun mRNA whose gene expression can be induced by TPA, cyclic AMP and growth factors. Recent findings suggest an involvement of reactive oxygen species in the pathway of TPA and protein kinase C leading to expression of c-fos and c-jun mRNA. To investigate the role of reactive oxygen species we studied the effects of alpha-lipoic acid and dihydrolipoic acid (natural thiol antioxidants) on the expression of c-fos mRNA in human Jurkat T cells. When cells were preincubated with dihydrolipoic acid (0.2 mM) the expression of c-fos mRNA was suppressed at 30 min after stimulation of TPA (0.5 microM) whereas in the case of preincubation of alpha-lipoic acid (0.2 microM), the expression was enhanced at 30 min. These studies support the idea that superoxide anion radical plays a role in the expression of c-fos mRNA.

Immunohistochemical study of the distribution of intercellular adhesion molecule-1 and lymphocyte function-associated antigen-1 in chronic type B hepatitis

The expression of intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function-associated antigen-1 (LFA-1) in the livers of 11 patients with chronic hepatitis B was studied immunohistochemically by light and electron microscopy to clarify the role of these adhesion molecules in tissue damage in chronic hepatitis B. On hepatocytes, ICAM-1 expression was confined to the bile canalicular surface when the liver inflammation was mild. In contrast, when the liver inflammation was severe, ICAM-1 was distributed on the entire surface of the hepatocyte, including the sinusoidal and lateral membranes; lymphocytes which were mostly positive for LFA-1, were often observed invading deeply among these hepatocytes. The degree of ICAM-1 expression on the hepatocytes was also related to the expression of HLA class 1 antigen. In liver showing diffuse expression of ICAM-1 on the hepatocytes, strong expression of HLA class 1 antigen was observed, and amounts of HBV in the liver were decreased. Diffuse expression of ICAM-1 and HLA class 1 antigen was mostly observed after acute exacerbation of liver inflammation. These results suggest that the ICAM-1/LFA-1 pathway is involved in the immunological mechanism responsible for liver cell damage in chronic hepatitis B.

Serial transcranial Doppler flow velocity and cerebral blood flow measurements for evaluation of cerebral vasospasm after subarachnoid hemorrhage

Serial transcranial Doppler (TCD) and cerebral blood flow (CBF) examinations were performed in 73 patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm to evaluate cerebral vasospasm. Twenty-six (35.6%) of the 73 patients developed ischemic neurological symptoms associated with cerebral vasospasm, which were reversible in all except four patients (5.5%) who demonstrated low-density areas associated with vasospasm on computed tomographic scans. In general, the flow velocities in the middle cerebral arteries began to increase soon after onset of SAH, reaching the maximum between days 8 and 10, subsequently decreasing gradually. There was no significant difference in the highest value and the time course of flow velocities between symptomatic vasospasm and asymptomatic vasospasm patients. Patients with symptomatic vasospasm demonstrated two typical time courses of flow velocities: rapid increases in flow velocities that preceded the clinical manifestations of vasospasm (16 patients, 61.5%), and no rapid increases in flow velocities despite the presence of ischemic symptoms (10 patients, 38.5%). In the latter, angiograms demonstrated vasospasm in segments distal to those evaluated by TCD examination. These results showed that the degree of cerebral vasospasm cannot be assessed only by the absolute flow velocities. CBF was measured two to 10 (mean 4.7) times within 3 weeks of SAH using the 133Xe intravenous injection method. The CBF value remained stable even during the period of major risk of vasospasm. However, the CBF was significantly lower in patients with symptomatic vasospasm on days 8, 9, 10, 13, 14, and 15, when compared with patients without symptomatic vasospasm.(ABSTRACT TRUNCATED AT 250 WORDS)

Cause of failure of lactation in mouse mammary tumor virus/human transforming growth factor alpha transgenic mice

Transgenic female mice bearing human transforming growth factor-alpha (TGF alpha) cDNA under the control of the mouse mammary tumor virus enhancer/promoter became pregnant but failed lactation. TGF alpha mRNA was detected in the mammary glands of these mice by the reverse transcriptase-polymerase chain reaction. By the use of collagenase-dissociated mammary epithelial cells, the binding of prolactin to its receptor was determined before and after parturition. At the end of pregnancy, the binding in TGF alpha transgenic (TGF alpha [+]) mice was small and its amount was comparable to that in the TGF alpha negative (TGF alpha [-]) mice. On the day of parturition, prolactin binding in TGF alpha (+) mice increased approximately 1.9-fold (insignificant), while that in TGF alpha (-) mice elevated over 5.3-fold (P < 0.01). The binding sites per cell were also higher in TGF alpha (-)mice. Radioimmunoassay of prolactin suggested that in TGF alpha (+) mice the low level of prolactin binding after parturition was not due to masking effect of serum prolactin. Among six TGF alpha (+) mice assayed, one mother with the highest prolactin binding activity (3.7-fold increase) initiated lactation, but the others did not. As there was little difference between groups in the growth and synthesis in the mammary glands, it was concluded that the failure of lactation in TGF alpha (+) mice is principally due to the lack of elevation of mammary prolactin receptor after parturition. At present, the role of TGF alpha in this process is obscure; however, TGF alpha was revealed not to interfere with the binding of prolactin to the receptor.

Liposomal transfection of human gamma-interferon gene into human glioma cells and adoptive immunotherapy using lymphokine-activated killer cells

The authors evaluated the effect of liposomal transfection of human gamma-interferon (HuIFN-gamma) gene into human glioma cells and lymphokine-activated killer (LAK) cells, alone and in combination. An HuIFN-gamma gene inserted in a eukaryotic expression vector was entrapped in liposomes bearing positive surface charges. Liposomal gene transfection induced production of HuIFN-gamma and its secretion in culture medium of human glioma cell lines (SK-MG-1 and U-251 MG). At 4 days after transfection, the cells produced 10 to 50 U/ml of HuIFN-gamma in the medium, whereby the major histocompatibility complex (MHC) class I and II antigens, as well as intercellular adhesion molecule-1 (ICAM-1), were induced on the glioma cell surface. The growth-inhibiting effect of transfection-induced HuIFN-gamma was much stronger in comparison with control cultures exposed to 500 U/ml of exogenously added HuIFN-gamma. In addition, 20% to 40% growth inhibition was obtained in the glioma cells when they were treated with LAK cells alone at a 5:1 ratio of effector to target cells. Liposomal transfection of HuIFN-gamma gene into human glioma cells combined with immunotherapy using LAK cells was more effective than either technique alone. The reinforcement of growth inhibition in the case of combined therapy was quenched by anti-ICAM-1 monoclonal antibody, but not by anti-MHC class I or II monoclonal antibodies. These results suggest that the combined effect of liposomal transfection of HuIFN-gamma gene plus LAK cells into human glioma cells is a potentially useful therapy for malignant glioma, and that the mechanisms of the reinforcement of growth inhibition are closely related to the expression of ICAM-1 on the glioma cell surface.

Post-caloric nystagmus by positional change. 2. Study in patients with spinocerebellar degeneration

We investigated the postcaloric nystagmus that is related to positional change in 24 patients with spinocerebellar degeneration (SCD) and compared it with that in normal subjects. Six ears of 3 patients exhibited no evaluable caloric response. In 42 ears of 21 patients, the primary phase of caloric nystagmus was definitely observed. In 37 of 42 (88%) ears, postcaloric nystagmus was observed. The postcaloric nystagmus from a positional change in patients with SCD was significantly larger than that in control subjects. Furthermore, it was significantly exaggerated in patients with brainstem and cerebellar lesions in comparison with patients with pure cerebellar lesions. The degree of disturbance coming from visual suppression had only a limited correlation with the exaggerated postcaloric nystagmus. Also discussed are possible other factors affecting the exaggerated postcaloric nystagmus.

The significance of the cervical soft disc herniation in the ossification of the posterior longitudinal ligament

The significance and role of cervical soft disc hernia in ossification of the posterior longitudinal ligament were investigated based on 54 surgical cases. The types of ossification of the posterior longitudinal ligament were divided into three sub-types: segmental, continuous, and mixed types. In the current series, there were 29 segmental type, 12 continuous type, and 13 mixed type. In the 29 segmental type, 23 patients had accompanying cervical disc hernias (79%). In the 12 continuous type, only 2 patients (17%), and in the 13 mixed type, 5 patients (33%), had accompanying disc hernias. According to the current study, an essential difference exists between the segmental type and the continuous or mixed types. In addition, the current result seems to indicate that, at least in the segmental type, disc herniation is not the promoting or initiating factor of ossification of the posterior longitudinal ligament, but that, in these cases, the fragility of the posterior longitudinal ligament may increase the chance of a disc hernia.

31P-NMR spectroscopy, rsEMG, and histochemical fiber types of human wrist flexor muscles

The metabolic response to graded rhythmic forearm exercise determined by phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy was evaluated with respect to recruitment pattern of muscles and to fiber type composition of the nondominant arm in 14 untrained subjects. Rectified smoothed surface electromyography (rsEMG) over finger and wrist flexor muscles increased similarly and progressively at 30, 45, and 60% of maximal exercise intensity. On the basis of the 31P-NMR response pattern during exercise, subjects were separated into three groups: H group (n = 4), with a single high-pH P(i) peak; M group (n = 7), with two P(i) peaks reflecting two pH components; and L group (n = 3), with a single low-pH P(i) peak. The H group demonstrated a faster recovery of P(i) and phosphocreatine than the L group (P < 0.05). The M group displayed both types of P(i) recovery and an intermediate resynthesis rate of phosphocreatine. The M group had an even distribution of slow- and fast-twitch fibers in the flexor carpi radialis muscle, whereas subjects in the H and L groups possessed a predominance of slow- and fast-twitch fibers, respectively. The results suggest that during rhythmic forearm exercise the interindividual NMR variation in energy metabolism is related closely to fiber type composition of the muscle.

Growth inhibition of subcutaneously transplanted human glioma by transfection-induced tumor necrosis factor-alpha and augmentation of the effect by gamma-interferon

Using subcutaneous solid tumors produced by U251-MG human glioma cells, we studied the in vivo transfection of the cells with the tumor necrosis factor-alpha (TNF-alpha) gene delivered by means of liposomes. When the tumor had become 7 mm in diameter, liposomes with entrapped TNF-alpha gene were injected into the center of the subcutaneous tumor. We found that mRNA of transfection-induced TNF-alpha, which was expressed in the tumor tissue, was detected by reverse transcriptase-polymerase chain reaction (RT-PCR) method and its protein was demonstrated by enzyme-linked immunoassay. Growth of the tumor was inhibited when the injection was carried out five times at every other day. The growth-inhibitory effect by transfection-induced TNF-alpha was much remarkable as compared with exogenous TNF-alpha and the effect was enhanced by the intraperitoneal injection of gamma-interferon (IFN-gamma) 12 h prior to intratumoral injection of the liposomes.

Interferon-beta endogenously produced by intratumoral injection of cationic liposome-encapsulated gene: cytocidal effect on glioma transplanted into nude mouse brain

The cytocidal effect of endogenously produced human interferon-beta was tested on glioma transplanted into the brain of nude mice by intracranial injection of a cell suspension of human glioma cell line U251-SP. When plasmid pSV2IFN-beta, bearing the human interferon-beta gene, was encapsulated into cationic multilamellar liposomes composed of N-(alpha-trimethylammonioacetyl)-didodecyl-D-glutamate chloride, dilauroyl phosphatidylcholine, and dioleoyl phosphatidylethanolamine in a molar ratio of 1:2:2 and injected intratumorally, human interferon-beta was produced in the tumor. The tumor completely disappeared if the injection was done shortly after the transplantation. Even when the tumor did not disappear, survival of the tumor-bearing nude mice was markedly prolonged. In control experiments made with normal brain having no glioma, interferon-beta was not detected.

Congenital abnormal eye movement without gaze nystagmus

Ten cases with congenital abnormal eye movements were reported. Eye movement abnormalities were confined to horizontal pursuit, OKN, and visual suppression. Horizontal saccade and VOR, and vertical eye movements were normal in most cases. Gaze nystagmus was not observed in any case. No serious lesion in the CNS concerning eye movements was detected. Although the cause of abnormal eye movements was not clear, congenital origin was postulated. Similar cases reported in the literature were discussed. These cases may be called "congenital nystagmus without gaze nystagmus."

Efficient transfection of human interferon-beta gene to human glioma cells by means of cationic multilamellar liposomes coupled with a monoclonal antibody [corrected]

We have been devoting our efforts to develop the useful liposomes that have high potentials of gene transfer and we aim human gene therapy for malignant glioma with cytokine genes. In our previous study, we prepared our original reverse-phase evaporation vesicles (REV) by an improved procedure of reverse-phase evaporation method. However, this procedure was very complicate. In this paper, a simple procedure for the preparation of cationic multilamellar vesicles (MLV) was introduced, and efficient expression and growth-inhibitory effect of MLV with entrapped human interferon-beta gene to glioma cells was comparable to that obtained with REV. Considering the present experiments, MLV seem to be more preferable for clinical application.

Postcaloric nystagmus by positional change. 1. Study in normal subjects

We investigated the postcaloric nystagmus related to positional change. Twenty-two healthy subjects were examined (experiment 1). A caloric test was carried out in the supine position. Following the cessation of the primary phase, the subject was reoriented to the upright position. An additional 10 subjects were also examined with other positional changes (experiment 2): following the cessation of the primary phase, the subject was reoriented to the lateral positions, irrigated-ear-up and irrigated-ear-down positions. As a control study, 6 subjects were examined without positional change (experiment 3). In 37 (84%) ears, postcaloric nystagmus was observed in the upright position. Furthermore, in 12 of 20 (60%) ears in the irrigated-ear-up position and in 13 of 20 (65%) ears in the irrigated-ear-down position, the horizontal component of postcaloric nystagmus was observed. Without positional change, no postcaloric nystagmus was observed. These findings indicate that caloric nystagmus is modified by an adaptive process and that postcaloric nystagmus as it relates to positional change might be attributed mainly to the vestibular adaptation.

Temporal pattern sensitivity of long-term potentiation in hippocampal CA1 neurons

High-frequency electrical stimulation in the hippocampus leads to an increase in synaptic efficacy that lasts for many hours. This long-term potentiation (LTP) of synaptic transmission is presumed to play a crucial role in learning and memory in the brain. However, the frequency of stimulation generally used to obtain LTP is beyond the normal physiological range of activity of hippocampal neurons. We found that LTP can be induced by an electrical stimulation whose frequency is comparable to that of the naturally occurring firing activity of hippocampal neurons if the stimulating pulse-interval train has a special time structure. In the present experiment, we compared the magnitude of LTP induced by the four types of stimuli which have the same pulse number and the same mean frequency but different time structure in interstimulus intervals. One type of stimuli has regular intervals, and this served as a control stimulus. In the other three types of stimuli, the adjacent interstimulus interval had the following statistical properties: in type 1, their correlations are positive; in type 2, negative; and in type 3, independent. The magnitude of LTP induced by these four types of stimuli showed clear order relationships: type 3/type 1 >> control > type 2. Detailed analysis of the evoked potential during a period of temporal pattern stimulation revealed that the amplitude of the population spikes of repetitive firing, especially of the second and third population spikes, had the same order relationship as the LTP.(ABSTRACT TRUNCATED AT 250 WORDS)

Indications and results of vascularized pedicle iliac bone graft in avascular necrosis of the femoral head

Several reports describe methods of treatment for avascular necrosis of the femoral head (ANFH) involving 0 to 2 mm of collapse. Some cases of ANFH have good prognoses, requiring only non-weight-bearing treatment. Other cases rapidly progress to collapse and complete destruction with enlargement of the necrotic area. The progression of the necrotic area is related to the activity of the original disease, steroid treatment, and the size and location of the necrotic area in the early stages of the disorder. In this report, a vascularized pedicle bone graft was used to treat ANFH, particularly those cases identified as Stage II on the system established by the Japanese Investigation Committee. Surgery involved curettage of necrotic bone, implantation of spongy bone, and application of a vascularized pedicle bone graft. Grafts were taken from the ilium and included the superficial circumflex iliac artery (SCIA). A bony canal was made in the anterior femoral neck, from which the necrotic bone was curetted and to which the bone graft was applied. The deep circumflex iliac artery (DCIA) was also used in combination with the SCIA. The postoperative weight-bearing period was six months. Follow-up periods lasted one to six years. Seventeen of 23 Stage II joints (19 cases) achieved satisfactory results at a mean of three years after surgery. Three Stage II joints and three Stage III joints continue to have significant problems. One of these six has been converted to a dual-bearing type endoprosthesis. The unsuccessful results generally occurred in patients who were treated with steroids.

[An epidemiological study on chronicity and incidence of hepatocellular carcinoma in the sequence of epidemic hepatitis]

From November 1951 to 1954, 416 patients in Kumayama Town, Okayama Prefecture, suffered from epidemic hepatitis, so-called "Kumayama Hepatitis". The mortality rate was 13.98% in the first one year, and the rate of progress to chronic hepatitis after 10 years was 24.6%. In the present study surveyed in 1991, 720 residents in this area had 13.6% positive anti-HCV (C100-3), significantly higher than in control areas. The rate of positive anti-HBs and abnormal liver functions in the subjects with positive anti-HCV was 42.9% and 40.8%, respectively. In 29 patients with clinically typical "Kumayama Hepatitis", the positivity rate of anti-HA IgG, anti-HBs, and anti-HCV, and the prevalence of abnormal liver function was 82.8%, 41.4%, 34.5%, and 10.3%, respectively. In conclusion, it is suggested that the hepatitis epidemic in Kumayama Town was caused by HAV and superinfected by HCV and/or HBV, then its clinical manifestations became complicated.

Natural history of advanced osteoarthritis of the hip

We followed long-term osteoarthritis of the hip clinically and radiographically in 38 patients (47 hips) finally reaching an advanced or terminal stage for more than 10 years. The relation between various measured parameters and disease progression and osteophyte formation was analyzed. By multivariate analysis, the clinical outcome of osteoarthritis of the hip could be correctly predicted in 91.5% of cases. In the cases in which initially the slope of the acetabular roof was not steep, the greater trochanter was low, and the cranial joint space was narrow, good roof osteophyte formation was well recognized. The cases with good roof osteophyte formation were characterized by preserved roundness of the femoral head, no shortening of the femoral neck, no lateralization of the femoral head, unchanged cranial joint space, and no worsening of pain at the final follow-up.