Lampang Hospital

Abstract Background Accurate intra-operative assessment of knee extension angle is essential in total knee arthroplasty (TKA), as residual flexion contracture or hyperextension is associated with inferior post-operative function and increased implant wear. Visual estimation remains widely used, but prior research has demonstrated substantial inaccuracy. This study evaluated the accuracy and reliability of a digital inclinometer technique for measuring knee extension angle during TKA, using computer navigation as the reference standard. Methods A prospective comparative study was performed on 130 knees undergoing primary posterior-stabilized TKA. After trial implant insertion, knee extension was assessed using two methods: visual estimation and a digital inclinometer method utilizing the femoral chisel holder and anterior border of the tibial crest. All measurements were compared with OrthoPilot navigation. Accuracy was defined as measurements within ± 2° of navigation. Correlation, agreement, and intra- and inter-observer reliability were evaluated. Results Visual estimation underestimated extension and showed a mean difference of − 3.5° ± 4.1° versus navigation (p < 0.001). The proportion of knees within ± 2° of navigation was only 26.2%. In comparison, the digital inclinometer demonstrated a significantly smaller mean difference of 0.1° ± 1.6° (p = 0.753), with 86.9% of knees meeting the ± 2° accuracy threshold. Superiority of the inclinometer persisted across all subgroups of pre-operative deformity. Correlation with navigation was weak for visual estimation (r = 0.320; r 2 = 0.102), but very strong for the inclinometer technique (r = 0.894; r 2 = 0.799; both p < 0.001). Bland–Altman analysis demonstrated minimal bias and no proportional error for the inclinometer, whereas visual estimation showed wide limits of agreement. Intra- and inter-observer reliability for inclinometer measurements was excellent (ICCs of 0.91 and 0.93), superior to visual estimation. Conclusion The digital inclinometer technique provides accurate and reproducible intra-operative knee extension measurements, outperforming visual estimation and approximating navigation-based assessment. This low-cost approach is feasible where navigation is unavailable. Trial registration Thai Clinical Trials Registry (TCTR20180828002). Registered on 28 August 2018. Prospectively registered.

Background/Objectives: Several chemotherapeutic regimens and targeted therapies are currently established as standard second-line treatments for patients with advanced biliary tract cancer (BTC). However, evidence regarding the benefits of treatment after first-line therapy failure remains limited, particularly among Thai populations. This study aimed to explore the efficacy of second-line chemotherapy in patients with advanced BTC. Methods: We conducted a single-institution, retrospective study including patients with locally advanced or metastatic BTC who experienced disease progression following first-line treatment between January 2017 and December 2019. Overall survival (OS) was defined as the primary endpoint. The secondary endpoint was the restricted mean survival time (RMST). To minimize confounding, propensity scores were estimated and applied using inverse probability of treatment weighting (IPTW). Results: A total of 110 patients were included, of whom 69 (62%) received second-line chemotherapy in combination with best supportive care (2LCMT + BSC), while 41 (38%) received best supportive care (BSC) alone. The majority of cases were intrahepatic cholangiocarcinoma (73.9% and 70.7% in each group, respectively). The median OS was 5.3 months (95% CI 3.5-7.0) in the 2LCMT + BSC group and 1.0 months (95% CI 0.5-1.9) in the BSC-only group (unadjusted HR 0.40, 95% CI 0.26-0.59; p < 0.001). In IPTW-adjusted flexible parametric regression analysis, second-line chemotherapy was associated with a 53% reduction in the risk of death compared with BSC alone (p = 0.009). The restricted mean survival time (RMST) differences between groups at 3, 6, and 12 months were 1.3 months (95% CI 0.9-1.6; p < 0.001), 2.6 months (95% CI 1.9-3.3; p < 0.001), and 3.9 months (95% CI 2.7-5.1; p < 0.001), sequentially. Conclusions: These findings demonstrate that second-line chemotherapy provides a significant overall survival benefit compared with best supportive care alone in patients with advanced BTC.

AIM:To compare the effects of individual glucagon-like peptide-1 receptor agonists (GLP-1RAs) on direct body composition among adults with overweight or obesity, with or without type 2 diabetes (T2D). METHODS:We systematically searched six electronic databases and grey literature from inception to 3 November 2025, to identify all randomised controlled trials (RCTs) that investigated individual GLP-1RAs on change in body composition from baseline among adults with overweight or obesity with or without T2D, without language restrictions. The main outcomes included total body fat (%), fat mass (kg), visceral adipose tissue (VAT) area (cm2), subcutaneous adipose tissue (SAT) area (cm2), liver fat content (%), total lean tissue (%) and lean mass (kg). A frequentist network meta-analysis was employed using a random-effects model and reported as standardised mean differences (SMDs). Certainty of evidence was appraised using the Confidence in Network Meta-Analysis. RESULTS:We identified 43 unique RCTs with 3379 participants that compared 17 different interventions or dosages with a control group. Regarding variations in treatment benefits on body composition, GLP-1RAs subcutaneously were more efficacious than the control group in decreasing total body fat, fat mass, VAT, SAT and liver fat from baseline. No significant differences for change in total lean tissue were observed. However, subcutaneously, liraglutide 1.8 mg/day, semaglutide 1.0 mg-weekly and tirzepatide 15 mg-weekly (SMDs ranged from -1.09 to -0.50) significantly decreased lean mass from baseline. CONCLUSIONS:GLP-1RAs substantially improve body composition-related excess adiposity, but unfavourable effects on lean mass were observed, particularly at high doses.

Purpose:Prediction stability is increasingly recognised as important for reliable clinical prediction model development, but the effect of continuous predictor modelling choices remains unclear. This study examined how these choices influence prediction stability. Patients and Methods:From a real clinical dataset of 19,418 emergency department patients we created five sample size scenarios (n = 437 to 8739), or 0.5 to 10 times the minimum required sample size. Seven modelling approaches were compared: median dichotomisation (DIC), tertiles (TER), linear (LIN), quadratic (QUA), restricted cubic splines (RCS), multivariable fractional polynomials (MFP), and extreme gradient boosting (XGB). For each scenario, 100 independent development samples were drawn from the full cohort to quantify Monte Carlo uncertainty, and within each, 200 bootstrap resamples served for internal validation and for assessing stability. For each individual, the mean absolute prediction error (MAPE) was the absolute difference between bootstrap-model and development-model predicted probabilities, averaged over the 200 resamples. A model met the stability criterion when at least 90% of individuals had MAPE ≤5%. Results were summarised across the 100 samples with Monte Carlo standard errors. Results:Prediction stability increased with sample size but differed by method. At n = 437, no method met the criterion in any development sample. LIN met it in all 100 samples from the base size (n = 874) onwards, and DIC in 79. QUA and RCS required approximately twice that size, MFP and XGB four times, and TER ten times. XGB ranked highest on optimism-corrected AUC at every size, but that value was greatest in the smallest samples; under out-of-bag correction XGB led only at the two largest. Its calibration slope reached 1.157 at n = 8739. Conclusion:In this empirical investigation, continuous predictor modelling methods appeared to influence prediction stability. LIN was consistently stable from the base sample size onwards, whereas more flexible approaches (eg, QUA, RCS, and MFP) and XGB generally required larger samples. These findings suggest that simpler methods may provide more stable predictions in smaller datasets, although borderline assessments of stability should be interpreted with caution.

Background Thailand has invested in domestic influenza vaccine manufacturing to strengthen health security, yet real-world evidence on the effectiveness of locally produced vaccines is limited. This study aimed to evaluate the effectiveness of a domestically produced trivalent inactivated split-virion influenza vaccine (GPO Tri Fluvac) against medically attended outpatient laboratory-confirmed influenza infection following its introduction into the population. Methods We conducted a phase IV test-negative case–control study among adults (≥18 years) presenting with influenza-like illness (ILI) in Lampang Province, Thailand, during the 2024–2025 influenza season. Laboratory-confirmed influenza was identified by RT-PCR. Vaccination status was obtained from hospital information system records. Vaccine effectiveness (VE) was estimated using multivariable logistic regression. Influenza virus clades and subclades were identified through viral genome sequencing. The study was registered in the Thai Clinical Trials Registry (TCTR20240909002). Findings Among 4975 participants with ILI, 703 (14%) had laboratory-confirmed influenza. GPO Tri Fluvac vaccination was received by 103 (15%) of 703 influenza cases and 1611 (38%) of 4272 test-negative controls. The adjusted VE of GPO Tri Fluvac against medically attended outpatient laboratory-confirmed influenza was 73.1% (95% CI: 66.3–78.5). Subgroup VE estimates by age group and virus subtype were presented descriptively. VE against hospitalization could not be reliably estimated because of the small number of severe outcomes. Genome sequencing showed that most circulating viruses belonged to the same major clades as the corresponding Southern Hemisphere 2024 vaccine strains included in GPO Tri Fluvac. Interpretation GPO Tri Fluvac provided substantial real-world protection against laboratory-confirmed influenza among adults in Thailand. These findings support its use in the national influenza vaccination program and highlight the value of domestic vaccine production for regional health security. Funding Thailand Science Research and Innovation through the National Vaccine Institute and the Government Pharmaceutical Organization.