const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "VLP vs External Fixation for Distal Radial Fractures - Journal Club";

// ── Color Palette ──────────────────────────────────────────────────────────
const C = {
  navy:    "0D2B4E",  // dominant dark bg
  teal:    "1A7FAD",  // section accent
  gold:    "F0A500",  // highlight / accent
  white:   "FFFFFF",
  light:   "E8F4FA",  // light body bg
  gray:    "445566",  // body text
  red:     "C0392B",  // warning / EF negative
  green:   "1E7A45",  // positive / VLP
  ltgray:  "D0D8E0",
};

// ── Reusable slide header ──────────────────────────────────────────────────
function addHeader(slide, title, color) {
  // Top bar
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.65, fill: { color: color || C.teal } });
  slide.addText(title, {
    x: 0.18, y: 0, w: 9.6, h: 0.65,
    fontSize: 20, bold: true, color: C.white, valign: "middle", margin: 0,
  });
}

function addFooter(slide) {
  slide.addText("JBJS 2021 | Wretenberg et al. | Journal Club", {
    x: 0, y: 5.3, w: 10, h: 0.32,
    fontSize: 8, color: C.ltgray, align: "center", valign: "middle",
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 1 – Title
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  // Dark gradient bg
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  // Teal accent strip
  s.addShape(pres.ShapeType.rect, { x: 0, y: 3.9, w: 10, h: 0.08, fill: { color: C.gold } });

  s.addText("JOURNAL CLUB", {
    x: 0.5, y: 0.4, w: 9, h: 0.5,
    fontSize: 13, bold: true, color: C.gold, align: "center", charSpacing: 5,
  });

  s.addText("Volar Locking Plate vs.\nExternal Fixation for\nDistal Radial Fractures", {
    x: 0.5, y: 0.95, w: 9, h: 2.3,
    fontSize: 34, bold: true, color: C.white, align: "center", valign: "middle",
  });

  s.addText("A Multicenter Randomized Controlled Trial", {
    x: 0.5, y: 3.15, w: 9, h: 0.5,
    fontSize: 16, italic: true, color: C.teal, align: "center",
  });

  s.addText([
    { text: "Wretenberg et al. | ", options: { bold: false } },
    { text: "J Bone Joint Surg Am", options: { italic: true } },
    { text: " 2021;103:405-414", options: { bold: false } },
  ], {
    x: 0.5, y: 4.05, w: 9, h: 0.5,
    fontSize: 13, color: C.ltgray, align: "center",
  });

  s.addText("Level of Evidence: Therapeutic Level I  •  JBJS.20.00275", {
    x: 0.5, y: 4.65, w: 9, h: 0.4,
    fontSize: 11, color: C.gold, align: "center",
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 2 – Background & Clinical Question
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Background & Clinical Question");
  addFooter(s);

  // Left column – background
  s.addShape(pres.ShapeType.rect, { x: 0.25, y: 0.85, w: 4.5, h: 4.1, fill: { color: C.white }, line: { color: C.ltgray, pt: 1 } });
  s.addText("Background", { x: 0.35, y: 0.9, w: 4.3, h: 0.4, fontSize: 13, bold: true, color: C.teal });
  s.addText([
    { text: "• Distal radial fractures are the most common fractures in adults\n", options: { breakLine: false } },
    { text: "• Displaced extra-articular types (OTA/AO A3) are common in active working-age patients\n", options: { breakLine: false } },
    { text: "• Both Volar Locking Plate (VLP) and External Fixation (EF) are established treatments\n", options: { breakLine: false } },
    { text: "• Earlier small RCTs reported conflicting results with methodological limitations\n", options: { breakLine: false } },
    { text: "• No definitive large RCT existed to guide practice", options: { breakLine: false } },
  ], {
    x: 0.35, y: 1.35, w: 4.3, h: 3.4,
    fontSize: 11.5, color: C.gray, lineSpacingMultiple: 1.3, bullet: false,
  });

  // Right column – PICO
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 0.85, w: 4.7, h: 4.1, fill: { color: C.navy }, line: { color: C.teal, pt: 1.5 } });
  s.addText("Clinical Question (PICO)", { x: 5.15, y: 0.9, w: 4.5, h: 0.4, fontSize: 13, bold: true, color: C.gold });

  const picoRows = [
    ["P", "Adults 18-70 yrs with displaced extra-articular distal radial fracture (OTA/AO type A3)"],
    ["I", "Volar Locking Plate (VLP) fixation"],
    ["C", "External Fixation (EF)"],
    ["O", "PRWHE score, QuickDASH, ROM, pain (VAS), radiographic outcomes, complications at 6 wk, 3 mo, 1 yr"],
  ];
  picoRows.forEach(([letter, text], i) => {
    const yy = 1.45 + i * 0.78;
    s.addShape(pres.ShapeType.roundRect, { x: 5.15, y: yy, w: 0.42, h: 0.42, fill: { color: C.gold }, rectRadius: 0.06 });
    s.addText(letter, { x: 5.15, y: yy, w: 0.42, h: 0.42, fontSize: 14, bold: true, color: C.navy, align: "center", valign: "middle", margin: 0 });
    s.addText(text, { x: 5.65, y: yy, w: 4.0, h: 0.6, fontSize: 10.5, color: C.white, valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 3 – Study Design & Methods
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Study Design & Methods", C.navy);
  addFooter(s);

  // Three info boxes
  const boxes = [
    {
      title: "Design", color: C.teal,
      lines: ["Multicenter RCT", "2 parallel treatment arms", "Norway (3 centers)", "Block randomization by biostatistician", "NCT01904084"],
    },
    {
      title: "Inclusion Criteria", color: C.green,
      lines: ["Age 18-70 years", "Displaced extra-articular distal", " radial fracture (OTA/AO A3)", "Fracture requiring operative treatment", ""],
    },
    {
      title: "Exclusion Criteria", color: C.red,
      lines: ["Intra-articular fractures", "Open fractures", "Bilateral fractures", "Dementia or psychiatric disorders", "Inability to comply with follow-up"],
    },
  ];

  boxes.forEach((b, i) => {
    const x = 0.18 + i * 3.27;
    s.addShape(pres.ShapeType.rect, { x, y: 0.8, w: 3.1, h: 4.5, fill: { color: C.white }, line: { color: b.color, pt: 2 } });
    s.addShape(pres.ShapeType.rect, { x, y: 0.8, w: 3.1, h: 0.5, fill: { color: b.color } });
    s.addText(b.title, { x: x + 0.05, y: 0.8, w: 3.0, h: 0.5, fontSize: 13, bold: true, color: C.white, valign: "middle", margin: 4 });
    b.lines.forEach((line, j) => {
      s.addText("• " + line, { x: x + 0.1, y: 1.45 + j * 0.62, w: 2.9, h: 0.55, fontSize: 11, color: C.gray });
    });
  });

  // Sample size note
  s.addShape(pres.ShapeType.rect, { x: 0.18, y: 5.0, w: 9.62, h: 0.35, fill: { color: C.navy } });
  s.addText("Sample size: 160 patients planned (80/group, α=0.05, power=80%, SD=21, MID=11.5 PRWHE pts) | Final: 75 VLP + 75 EF = 150 randomized", {
    x: 0.2, y: 5.0, w: 9.6, h: 0.35,
    fontSize: 9.5, color: C.white, align: "center", valign: "middle",
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 4 – Patient Flow (CONSORT)
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Patient Flow (CONSORT Diagram)", C.teal);
  addFooter(s);

  // Central box: Enrolled
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 0.85, w: 3, h: 0.65, fill: { color: C.navy }, line: { color: C.teal, pt: 1 } });
  s.addText("Assessed for eligibility\n(n = 160 planned)", { x: 3.5, y: 0.85, w: 3, h: 0.65, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle" });

  // Arrow down
  s.addShape(pres.ShapeType.line, { x: 5, y: 1.5, w: 0, h: 0.35, line: { color: C.gray, pt: 1.5 } });
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 1.85, w: 3, h: 0.65, fill: { color: C.teal }, line: { color: C.navy, pt: 1 } });
  s.addText("Randomized\n(n = 150)", { x: 3.5, y: 1.85, w: 3, h: 0.65, fontSize: 11, bold: true, color: C.white, align: "center", valign: "middle" });

  // Arrow left and right
  s.addShape(pres.ShapeType.line, { x: 3.5, y: 2.17, w: -1.8, h: 0, line: { color: C.gray, pt: 1.5 } });
  s.addShape(pres.ShapeType.line, { x: 6.5, y: 2.17, w: 1.8, h: 0, line: { color: C.gray, pt: 1.5 } });
  s.addShape(pres.ShapeType.line, { x: 1.7, y: 2.17, w: 0, h: 0.45, line: { color: C.gray, pt: 1.5 } });
  s.addShape(pres.ShapeType.line, { x: 8.3, y: 2.17, w: 0, h: 0.45, line: { color: C.gray, pt: 1.5 } });

  // VLP group box
  s.addShape(pres.ShapeType.rect, { x: 0.4, y: 2.62, w: 2.6, h: 0.7, fill: { color: C.green }, line: { color: C.navy, pt: 1 } });
  s.addText("VLP Group\n(n = 75)", { x: 0.4, y: 2.62, w: 2.6, h: 0.7, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  // EF group box
  s.addShape(pres.ShapeType.rect, { x: 7.0, y: 2.62, w: 2.6, h: 0.7, fill: { color: C.red }, line: { color: C.navy, pt: 1 } });
  s.addText("EF Group\n(n = 75)", { x: 7.0, y: 2.62, w: 2.6, h: 0.7, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  // Follow-up rows
  const fuLabels = ["6 Weeks", "3 Months", "1 Year"];
  const fuVLP =    ["n = 75",   "n = 75",   "n = 71"];
  const fuEF  =    ["n = 75",   "n = 75",   "n = 71"];
  fuLabels.forEach((label, i) => {
    const y = 3.55 + i * 0.5;
    s.addShape(pres.ShapeType.rect, { x: 3.7, y, w: 2.6, h: 0.38, fill: { color: C.ltgray } });
    s.addText(label, { x: 3.7, y, w: 2.6, h: 0.38, fontSize: 10, bold: true, color: C.navy, align: "center", valign: "middle" });
    s.addText(fuVLP[i], { x: 0.45, y, w: 2.5, h: 0.38, fontSize: 10, color: C.green, align: "center", valign: "middle" });
    s.addText(fuEF[i],  { x: 7.05, y, w: 2.5, h: 0.38, fontSize: 10, color: C.red,   align: "center", valign: "middle" });
  });
  s.addText("8 lost / excluded (ITT analysis performed)", {
    x: 2.5, y: 5.05, w: 5, h: 0.35, fontSize: 9.5, italic: true, color: C.gray, align: "center",
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 5 – Primary Outcome: PRWHE Score
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  addHeader(s, "Primary Outcome: Patient-Rated Wrist/Hand Evaluation (PRWHE)", C.teal);
  addFooter(s);

  // PRWHE explanation box
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.75, w: 9.6, h: 0.55, fill: { color: C.gray } });
  s.addText("PRWHE score range: 0–100  •  Lower = Better  •  MID (minimal important difference) = 11.5 points  •  Primary outcome at 6 wk, 3 mo, 1 yr", {
    x: 0.2, y: 0.75, w: 9.6, h: 0.55, fontSize: 10, color: C.white, align: "center", valign: "middle",
  });

  // Table header
  const cols = [2.2, 1.8, 1.8, 1.8, 1.6];
  const headers = ["Timepoint", "VLP (mean±SD)", "EF (mean±SD)", "Difference", "P value"];
  const hcolors = [C.navy, C.green, C.red, C.gold, C.teal];
  let cx = 0.2;
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: cx, y: 1.42, w: cols[i], h: 0.42, fill: { color: hcolors[i] } });
    s.addText(h, { x: cx + 0.05, y: 1.42, w: cols[i] - 0.1, h: 0.42, fontSize: 11, bold: true, color: C.white, valign: "middle", align: "center" });
    cx += cols[i];
  });

  // Data rows
  const rows = [
    ["6 Weeks",   "30 ± 21", "46 ± 22", "−16 pts", "< 0.001"],
    ["3 Months",  "15 ± 15", "21 ± 18", "−6 pts",  "0.016"],
    ["1 Year",    "8 ± 12",  "11 ± 13", "−3 pts",  "0.13"],
  ];
  const rowBg = [C.light, "F5FBFF", C.light];
  rows.forEach((row, ri) => {
    cx = 0.2;
    const yy = 1.86 + ri * 0.62;
    cols.forEach((w, ci) => {
      s.addShape(pres.ShapeType.rect, { x: cx, y: yy, w, h: 0.56, fill: { color: rowBg[ri % 2] }, line: { color: C.ltgray, pt: 0.5 } });
      s.addText(row[ci], {
        x: cx + 0.05, y: yy, w: w - 0.1, h: 0.56,
        fontSize: 12, color: ci === 4 ? (ri < 2 ? C.green : C.red) : C.gray,
        bold: ci === 4, align: "center", valign: "middle",
      });
      cx += w;
    });
  });

  // Key finding callout
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.1, w: 9.6, h: 0.85, fill: { color: C.teal }, line: { color: C.gold, pt: 2 } });
  s.addText([
    { text: "Key Finding: ", options: { bold: true, color: C.gold } },
    { text: "VLP showed significantly better PRWHE at 6 weeks and 3 months. At 1 year, no significant difference was detected (p = 0.13). VLP provides ", options: { color: C.white } },
    { text: "faster functional recovery", options: { bold: true, color: C.gold } },
    { text: " but equivalent long-term outcomes.", options: { color: C.white } },
  ], { x: 0.3, y: 4.1, w: 9.4, h: 0.85, fontSize: 11.5, valign: "middle" });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 6 – Secondary Outcomes: Range of Motion & QuickDASH
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Secondary Outcomes: Range of Motion & QuickDASH", C.teal);
  addFooter(s);

  // ROM table
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 0.75, w: 5.7, h: 0.42, fill: { color: C.navy } });
  s.addText("Range of Motion (% of uninjured side)", { x: 0.2, y: 0.75, w: 5.7, h: 0.42, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  const romData = [
    ["Motion",       "VLP 6wk", "EF 6wk", "p", "VLP 1yr", "EF 1yr", "p 1yr"],
    ["Flexion",      "68.6%",   "54.8%",  "<0.001", "97%",  "94%",  "0.66"],
    ["Extension",    "62.0%",   "3.8%",   "<0.001", "93%",  "91%",  "0.013"],
    ["Supination",   "74.1%",   "42.5%",  "<0.001", "99%",  "93%",  "0.03"],
    ["Grip Strength","~69%",    "~51%",   "<0.001", "97%",  "95%",  "0.70"],
  ];
  const cw2 = [1.3, 0.78, 0.78, 0.55, 0.78, 0.78, 0.55];
  romData.forEach((row, ri) => {
    let cx2 = 0.2;
    cw2.forEach((w, ci) => {
      const isHeader = ri === 0;
      const bg = isHeader ? C.teal : (ri % 2 === 0 ? "EBF5FB" : C.white);
      s.addShape(pres.ShapeType.rect, { x: cx2, y: 1.18 + ri * 0.44, w, h: 0.42, fill: { color: bg }, line: { color: C.ltgray, pt: 0.4 } });
      s.addText(row[ci], {
        x: cx2 + 0.02, y: 1.18 + ri * 0.44, w: w - 0.04, h: 0.42,
        fontSize: isHeader ? 8.5 : 10, bold: isHeader, color: isHeader ? C.white : C.gray,
        align: "center", valign: "middle",
      });
      cx2 += w;
    });
  });

  // QuickDASH
  s.addShape(pres.ShapeType.rect, { x: 6.1, y: 0.75, w: 3.7, h: 0.42, fill: { color: C.navy } });
  s.addText("QuickDASH Score (lower = better)", { x: 6.1, y: 0.75, w: 3.7, h: 0.42, fontSize: 12, bold: true, color: C.white, align: "center", valign: "middle" });

  const dashData = [
    ["Timepoint", "VLP",  "EF",   "p"],
    ["6 Weeks",   "27",   "45",   "<0.001"],
    ["3 Months",  "15",   "22",   "0.023"],
    ["1 Year",    "9",    "12",   "0.36"],
  ];
  const cw3 = [1.3, 0.78, 0.78, 0.78];
  dashData.forEach((row, ri) => {
    let cx3 = 6.1;
    cw3.forEach((w, ci) => {
      const isHeader = ri === 0;
      const bg = isHeader ? C.teal : (ri % 2 === 0 ? "EBF5FB" : C.white);
      s.addShape(pres.ShapeType.rect, { x: cx3, y: 1.18 + ri * 0.44, w, h: 0.42, fill: { color: bg }, line: { color: C.ltgray, pt: 0.4 } });
      s.addText(row[ci], {
        x: cx3 + 0.02, y: 1.18 + ri * 0.44, w: w - 0.04, h: 0.42,
        fontSize: isHeader ? 9 : 11, bold: isHeader, color: isHeader ? C.white : C.gray,
        align: "center", valign: "middle",
      });
      cx3 += w;
    });
  });

  // Recovery callout
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 3.4, w: 9.6, h: 0.58, fill: { color: C.teal } });
  s.addText("Full Recovery (PRWHE ≤ 10):  6 wk – VLP 23% vs EF 6%  |  3 mo – VLP 58% vs EF 47%  |  1 yr – VLP 81% vs EF 79%", {
    x: 0.2, y: 3.4, w: 9.6, h: 0.58, fontSize: 11, bold: false, color: C.white, align: "center", valign: "middle",
  });

  // Pain VAS
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.08, w: 9.6, h: 0.38, fill: { color: C.navy } });
  s.addText("Pain (VAS): No significant difference at rest at any timepoint. VLP had significantly less pain during activity at 3 months and 1 year.", {
    x: 0.25, y: 4.08, w: 9.5, h: 0.38, fontSize: 10, color: C.white, align: "center", valign: "middle",
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 7 – Complications
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Complications", C.red);
  addFooter(s);

  // Major complications
  s.addText("Major Complications", { x: 0.3, y: 0.78, w: 4.5, h: 0.38, fontSize: 13, bold: true, color: C.red });
  const major = [
    ["Complication",          "VLP (n=75)", "EF (n=75)", "p"],
    ["CRPS",                  "4%",         "11%",       "0.14"],
    ["Carpal Tunnel Syndrome","7%",          "4%",        "0.49"],
    ["Prolonged Wrist Pain",  "3%",          "3%",        "1.0"],
    ["Deep Infection",        "1%",          "0%",        "1.0"],
    ["Suboptimal Osteosynthesis","1%",       "4%",        "0.62"],
    ["Plate Removal",         "7%",          "—",         "0.025*"],
    ["Total Major",           "23%",         "25%",       "0.83"],
  ];
  const mw = [2.2, 1.1, 1.1, 0.9];
  major.forEach((row, ri) => {
    let cx = 0.2;
    mw.forEach((w, ci) => {
      const isHeader = ri === 0;
      const isTotal = ri === major.length - 1;
      const bg = isHeader ? C.navy : isTotal ? C.teal : (ri % 2 === 0 ? "F9ECEC" : C.white);
      s.addShape(pres.ShapeType.rect, { x: cx, y: 1.2 + ri * 0.44, w, h: 0.42, fill: { color: bg }, line: { color: C.ltgray, pt: 0.4 } });
      s.addText(row[ci], {
        x: cx + 0.03, y: 1.2 + ri * 0.44, w: w - 0.06, h: 0.42,
        fontSize: isHeader ? 9 : 10, bold: isHeader || isTotal,
        color: isHeader || isTotal ? C.white : C.gray, align: ci === 0 ? "left" : "center", valign: "middle",
      });
      cx += w;
    });
  });

  // Minor complications
  s.addText("Minor Complications", { x: 5.5, y: 0.78, w: 4.3, h: 0.38, fontSize: 13, bold: true, color: C.gray });
  const minor = [
    ["Complication",     "VLP", "EF",  "p"],
    ["Superficial Infxn","1%",  "10%", "0.063"],
    ["Scar Tissue",      "7%",  "8%",  "0.83"],
    ["Paresthesia",      "6%",  "7%",  "1.0"],
    ["Neuropathy",       "3%",  "3%",  "1.0"],
    ["Total Minor",      "25%", "32%", "0.36"],
  ];
  const mw2 = [1.8, 0.9, 0.9, 0.9];
  minor.forEach((row, ri) => {
    let cx = 5.5;
    mw2.forEach((w, ci) => {
      const isHeader = ri === 0;
      const isTotal = ri === minor.length - 1;
      const bg = isHeader ? C.navy : isTotal ? C.teal : (ri % 2 === 0 ? "ECF5EC" : C.white);
      s.addShape(pres.ShapeType.rect, { x: cx, y: 1.2 + ri * 0.44, w, h: 0.42, fill: { color: bg }, line: { color: C.ltgray, pt: 0.4 } });
      s.addText(row[ci], {
        x: cx + 0.03, y: 1.2 + ri * 0.44, w: w - 0.06, h: 0.42,
        fontSize: isHeader ? 9 : 10, bold: isHeader || isTotal,
        color: isHeader || isTotal ? C.white : C.gray, align: ci === 0 ? "left" : "center", valign: "middle",
      });
      cx += w;
    });
  });

  // Note
  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.85, w: 9.6, h: 0.45, fill: { color: C.navy } });
  s.addText("* Plate removal was unique to VLP (5/75, 7%). EF showed trend toward more CRPS (11% vs 4%, p=0.14) and superficial infection (10% vs 1%, p=0.063). No significant difference in overall complication rate.", {
    x: 0.25, y: 4.85, w: 9.5, h: 0.45, fontSize: 9.5, italic: true, color: C.ltgray, align: "center", valign: "middle",
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 8 – Radiographic Outcomes
// ══════════════════════════════════════════════════════════════════════════
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  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Radiographic Outcomes", C.navy);
  addFooter(s);

  s.addText("Radiographic parameters were measured at 6 weeks, 3 months, and 1 year postoperatively.", {
    x: 0.25, y: 0.75, w: 9.5, h: 0.4, fontSize: 11.5, italic: true, color: C.gray,
  });

  const radRows = [
    ["Parameter", "VLP 6wk", "EF 6wk", "VLP 1yr", "EF 1yr", "Favors"],
    ["Radial Inclination", "22°", "20°", "22°", "21°", "VLP"],
    ["Volar Tilt", "8°", "4°", "9°", "6°", "VLP"],
    ["Radial Height", "12mm", "10mm", "12mm", "11mm", "VLP"],
    ["Ulnar Variance", "0.3mm", "1.2mm", "0.2mm", "0.8mm", "VLP"],
  ];
  const rw = [2.3, 1.3, 1.3, 1.3, 1.3, 1.3];
  radRows.forEach((row, ri) => {
    let cx = 0.2;
    rw.forEach((w, ci) => {
      const isHeader = ri === 0;
      const isFavor = ci === 5;
      const bg = isHeader ? C.teal : isFavor ? C.green : (ri % 2 === 0 ? "EBF5FB" : C.white);
      s.addShape(pres.ShapeType.rect, { x: cx, y: 1.25 + ri * 0.5, w, h: 0.48, fill: { color: bg }, line: { color: C.ltgray, pt: 0.4 } });
      s.addText(row[ci], {
        x: cx + 0.04, y: 1.25 + ri * 0.5, w: w - 0.08, h: 0.48,
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        align: "center", valign: "middle",
      });
      cx += w;
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  s.addShape(pres.ShapeType.rect, { x: 0.2, y: 4.0, w: 9.6, h: 0.75, fill: { color: C.teal } });
  s.addText([
    { text: "VLP maintained significantly better radiographic alignment at all timepoints.", options: { bold: true, color: C.gold } },
    { text: " Anatomic reduction achieved more reliably with VLP. Despite radiographic differences, 1-year functional outcomes were similar, suggesting", options: { color: C.white } },
    { text: " moderate correlation between radiographic and functional results.", options: { italic: true, color: C.ltgray } },
  ], { x: 0.3, y: 4.0, w: 9.4, h: 0.75, fontSize: 11, valign: "middle" });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 9 – Strengths & Limitations
// ══════════════════════════════════════════════════════════════════════════
{
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.light } });
  addHeader(s, "Critical Appraisal: Strengths & Limitations", C.gray);
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  s.addText("✓  Strengths", { x: 0.2, y: 0.78, w: 4.6, h: 0.45, fontSize: 13, bold: true, color: C.white, valign: "middle", margin: 8 });
  const strengths = [
    "Level I RCT – highest level of therapeutic evidence",
    "Multicenter design (3 Norwegian centers) improves generalizability",
    "Block randomization by independent biostatistician",
    "ITT analysis maintained allocation integrity",
    "Validated PROMs: PRWHE + QuickDASH",
    "Multiple timepoints: 6 wk, 3 mo, 1 yr",
    "Blinded radiographic assessment",
    "Adequate power calculation performed a priori",
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  const limitations = [
    "Follow-up limited to 1 year – no long-term data",
    "Only extra-articular A3 fractures – limited generalizability",
    "Cannot blind patients or surgeons to treatment",
    "Norwegian population – may not reflect other demographics",
    "Surgeon experience with both methods not standardized",
    "No cost-effectiveness analysis reported",
    "Post-op rehabilitation protocols not fully standardized",
  ];
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  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 10 – Key Messages & Discussion Points
// ══════════════════════════════════════════════════════════════════════════
{
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  addHeader(s, "Discussion Points for Journal Club", C.teal);
  addFooter(s);

  const discussion = [
    {
      q: "Is 1-year follow-up sufficient?",
      a: "Distal radius fractures may continue to remodel. Longer follow-up needed to assess arthritic change, implant failure, or late CRPS.",
    },
    {
      q: "Does faster recovery justify higher cost of VLP?",
      a: "VLP hardware is significantly more expensive. Earlier return-to-work may offset cost in younger working-age patients.",
    },
    {
      q: "Generalizability to intra-articular fractures?",
      a: "This trial excluded intra-articular types – VLP advantage may be even greater where exact reduction is critical.",
    },
    {
      q: "Plate removal in 7% of VLP patients – significant?",
      a: "EF avoids plate removal but has higher CRPS trend (11%) and more superficial infections. Trade-off differs by patient profile.",
    },
    {
      q: "Role of surgeon volume/learning curve?",
      a: "VLP requires more surgical skill. Outcomes at lower-volume centers may differ. Multicenter design partially addresses this.",
    },
  ];

  discussion.forEach((item, i) => {
    const y = 0.82 + i * 0.88;
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    s.addText(item.a, { x: 0.62, y: y + 0.36, w: 9.1, h: 0.4, fontSize: 10, color: C.gray });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 11 – Conclusions
// ══════════════════════════════════════════════════════════════════════════
{
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 5.625, fill: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.9, w: 10, h: 0.1, fill: { color: C.gold } });
  addFooter(s);

  s.addText("Conclusions", {
    x: 0.5, y: 0.25, w: 9, h: 0.65,
    fontSize: 26, bold: true, color: C.gold, align: "center",
  });

  const conclusions = [
    { icon: "1", text: "VLP provides significantly faster functional recovery than EF at 6 weeks and 3 months post-op for OTA/AO type A3 distal radial fractures." },
    { icon: "2", text: "At 1 year, no statistically significant difference in PRWHE or QuickDASH scores between VLP and EF." },
    { icon: "3", text: "VLP demonstrated better range of motion (particularly extension and supination) throughout follow-up." },
    { icon: "4", text: "Complication profiles differ: VLP carries a 7% plate removal rate; EF has a trend toward more CRPS and superficial infection." },
    { icon: "5", text: "VLP should be considered the preferred treatment for displaced extra-articular distal radial fractures, especially in patients requiring earlier return to function." },
  ];

  conclusions.forEach((c, i) => {
    const y = 0.98 + i * 0.72;
    s.addShape(pres.ShapeType.rect, { x: 0.35, y, w: 0.48, h: 0.52, fill: { color: C.gold } });
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    s.addText(c.text, { x: 0.93, y: y + 0.03, w: 8.8, h: 0.52, fontSize: 12, color: C.white, valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════
// SLIDE 12 – Thank You / References
// ══════════════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 2.55, w: 10, h: 0.06, fill: { color: C.gold } });

  s.addText("Thank You", {
    x: 0.5, y: 0.35, w: 9, h: 1.2,
    fontSize: 48, bold: true, color: C.white, align: "center", valign: "middle",
  });
  s.addText("Questions & Discussion", {
    x: 0.5, y: 1.55, w: 9, h: 0.6,
    fontSize: 20, italic: true, color: C.teal, align: "center",
  });

  s.addText("Citation", { x: 0.5, y: 2.8, w: 9, h: 0.4, fontSize: 13, bold: true, color: C.gold });
  s.addText(
    "Wretenberg P, et al. Volar Locking Plate Versus External Fixation for Displaced Extra-Articular Distal Radial Fractures: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2021;103(5):405-414. doi: JBJS.20.00275",
    { x: 0.5, y: 3.25, w: 9, h: 0.8, fontSize: 11, color: C.ltgray, italic: true }
  );

  s.addText("Level of Evidence I  •  Therapeutic RCT  •  ClinicalTrials.gov: NCT01904084", {
    x: 0.5, y: 4.2, w: 9, h: 0.4, fontSize: 11, color: C.gold, align: "center",
  });
}

// ── Write file ─────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/journal-club-vlp-ef/VLP_vs_EF_JournalClub.pptx" })
  .then(() => console.log("DONE"))
  .catch(e => { console.error(e); process.exit(1); });

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Journal Club – Conversion to Arthroplasty After IF of Nondisplaced FNF";

// ── Palette ────────────────────────────────────────────────────────────────
const C = {
  navy:   "0D2B4E",
  teal:   "1A6B8A",
  gold:   "D4960A",
  white:  "FFFFFF",
  light:  "EEF4F8",
  gray:   "3D4F5C",
  ltgray: "C8D6DE",
  green:  "1B6B3A",
  red:    "9E2A2B",
  orange: "C85A00",
  mid:    "2B5170",
};

function hdr(s, title, bg) {
  bg = bg || C.teal;
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  s.addText(title, { x:0.18, y:0, w:9.6, h:0.62, fontSize:19, bold:true, color:C.white, valign:"middle", margin:0 });
}
function ftr(s, txt) {
  s.addText(txt || "Lagergren et al. JBJS 2023 | Journal Club", {
    x:0, y:5.32, w:10, h:0.3, fontSize:8, color:C.ltgray, align:"center", valign:"middle",
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE / PAPER SNAPSHOT
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.navy}});
  s.addShape(pres.ShapeType.rect, {x:0,y:3.82,w:10,h:0.06,fill:{color:C.gold}});

  // Tag line
  s.addText("JOURNAL CLUB", {
    x:0.5,y:0.28,w:9,h:0.42,
    fontSize:12,bold:true,color:C.gold,align:"center",charSpacing:5,
  });

  // Main title
  s.addText("Conversion to Arthroplasty After\nInternal Fixation of Nondisplaced\nFemoral Neck Fractures", {
    x:0.5,y:0.72,w:9,h:2.2,
    fontSize:30,bold:true,color:C.white,align:"center",valign:"middle",
  });

  s.addText("Results from a Swedish Register Cohort of 5,428 Individuals ≥60 Years of Age", {
    x:0.5,y:2.95,w:9,h:0.5,
    fontSize:14,italic:true,color:C.teal,align:"center",
  });

  s.addShape(pres.ShapeType.rect, {x:0.5,y:3.95,w:9,h:1.35,fill:{color:C.mid}});

  // Paper info grid
  const info = [
    ["Published in",    "The Journal of Bone & Joint Surgery (JBJS Am)"],
    ["Date",            "March 1, 2023  |  DOI: 10.2106/JBJS.22.01035"],
    ["Authors",         "Lagergren J, Mukka S, Wolf O, Nauclér E, Möller M, Rogmark C"],
    ["IF / Level",      "Impact Factor 4.3  •  Level of Evidence: Prognostic Level III"],
  ];
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    s.addText(val,         { x:2.3,  y:4.02+i*0.3, w:7.0, h:0.28, fontSize:9.5, color:C.white });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 – BACKGROUND & RATIONALE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.light}});
  hdr(s,"Background & Rationale");
  ftr(s);

  // Left: context points
  const pts = [
    ["Nondisplaced FNF",        "Most nondisplaced or minimally displaced femoral neck fractures (Garden I–II) are routinely treated with internal fixation (IF)."],
    ["High secondary procedure rate", "Despite stable fracture morphology, high rates of secondary surgical procedures are well documented, especially in the elderly."],
    ["Primary arthroplasty debate",   "Primary arthroplasty for nondisplaced FNF in elderly patients has been proposed as an alternative to reduce reoperations."],
    ["Gap in literature",             "Few large-scale registry studies quantify the actual conversion rate and identify which subgroups are at highest risk."],
  ];

  pts.forEach(([title,body],i) => {
    const y = 0.75 + i*1.1;
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    s.addText((i+1).toString(), {x:0.2,y,w:0.45,h:0.45,fontSize:15,bold:true,color:C.white,align:"center",valign:"middle",margin:0});
    s.addText(title, {x:0.75,y:y+0.02,w:8.9,h:0.3,fontSize:12,bold:true,color:C.navy});
    s.addText(body,  {x:0.75,y:y+0.34,w:8.9,h:0.6,fontSize:11,color:C.gray});
  });

  // Aim box
  s.addShape(pres.ShapeType.rect, {x:0.2,y:5.04,w:9.6,h:0.38,fill:{color:C.navy}});
  s.addText([
    {text:"Aim: ", options:{bold:true,color:C.gold}},
    {text:"To describe the rate of conversion to arthroplasty within 5 years after IF of nondisplaced FNF in patients ≥60 years, using national registry data.", options:{color:C.white}},
  ], {x:0.3,y:5.04,w:9.4,h:0.38,fontSize:10,valign:"middle"});
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 – STUDY DESIGN & METHODS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.light}});
  hdr(s,"Study Design & Methods",C.navy);
  ftr(s);

  // Left column
  s.addShape(pres.ShapeType.rect, {x:0.2,y:0.72,w:4.5,h:4.6,fill:{color:C.white},line:{color:C.ltgray,pt:1}});
  s.addShape(pres.ShapeType.rect, {x:0.2,y:0.72,w:4.5,h:0.44,fill:{color:C.teal}});
  s.addText("Design", {x:0.25,y:0.72,w:4.4,h:0.44,fontSize:12,bold:true,color:C.white,valign:"middle",margin:6});

  const design = [
    ["Study type","Observational cohort study (registry-based)"],
    ["Data source","Swedish Fracture Register (SFR) cross-matched with Swedish Arthroplasty Register (SAR)"],
    ["Time period","2012 – 2018 (6 years)"],
    ["Follow-up","Up to 5 years post-fracture"],
    ["Population","5,428 nondisplaced FNF in patients ≥60 years"],
    ["Analysis","Competing risk analysis (conversion vs. death)"],
  ];
  design.forEach(([k,v],i) => {
    s.addText(k+":", {x:0.3,y:1.24+i*0.6,w:1.55,h:0.55,fontSize:10,bold:true,color:C.teal,valign:"top"});
    s.addText(v,     {x:1.88,y:1.24+i*0.6,w:2.7, h:0.55,fontSize:10,color:C.gray,valign:"top"});
  });

  // Right column
  s.addShape(pres.ShapeType.rect, {x:5.1,y:0.72,w:4.7,h:4.6,fill:{color:C.white},line:{color:C.ltgray,pt:1}});
  s.addShape(pres.ShapeType.rect, {x:5.1,y:0.72,w:4.7,h:0.44,fill:{color:C.navy}});
  s.addText("Inclusion / Exclusion", {x:5.15,y:0.72,w:4.6,h:0.44,fontSize:12,bold:true,color:C.white,valign:"middle",margin:6});

  s.addText("Inclusion:", {x:5.2,y:1.24,w:4.5,h:0.28,fontSize:11,bold:true,color:C.green});
  const inc = [
    "Age ≥60 years at time of fracture",
    "Nondisplaced femoral neck fracture (Garden I–II)",
    "Treated with internal fixation (cannulated screws / sliding hip screw)",
    "Registered in SFR 2012–2018",
  ];
  inc.forEach((t,i) => s.addText("• "+t, {x:5.25,y:1.56+i*0.44,w:4.45,h:0.42,fontSize:10.5,color:C.gray}));

  s.addText("Exclusion:", {x:5.2,y:3.4,w:4.5,h:0.28,fontSize:11,bold:true,color:C.red});
  const exc = [
    "Displaced femoral neck fractures",
    "Age <60 years",
    "Missing/incomplete registry data",
  ];
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}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 – PATIENT CHARACTERISTICS (Demographics)
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.light}});
  hdr(s,"Patient Characteristics",C.teal);
  ftr(s);

  // Summary stat boxes
  const stats = [
    {n:"5,428",  label:"Total patients included", color:C.navy},
    {n:"≥60 yrs",label:"Age at time of fracture", color:C.teal},
    {n:"~67%",   label:"Female patients",         color:C.orange},
    {n:"6 yrs",  label:"Registry period (2012–2018)", color:C.green},
  ];
  stats.forEach((st,i) => {
    const x = 0.2 + i*2.43;
    s.addShape(pres.ShapeType.rect, {x,y:0.72,w:2.3,h:1.1,fill:{color:st.color},line:{color:C.white,pt:1.5}});
    s.addText(st.n,     {x,y:0.72,w:2.3,h:0.65,fontSize:24,bold:true,color:C.white,align:"center",valign:"middle"});
    s.addText(st.label, {x,y:1.3, w:2.3,h:0.5, fontSize:9.5,color:C.white,align:"center",valign:"middle"});
  });

  // Age group breakdown table
  s.addText("Age Group Breakdown", {x:0.2,y:1.98,w:4.8,h:0.35,fontSize:12,bold:true,color:C.navy});
  const ageRows = [
    ["Age Group", "n (approx)", "% of Cohort", "2-yr Conversion"],
    ["60–69 years", "~1,300",  "24%", "6.5%"],
    ["70–79 years", "~2,200",  "40%", "9.6%"],
    ["≥80 years",   "~1,900",  "35%", "7.8%"],
  ];
  const aw = [1.8,1.2,1.2,1.5];
  ageRows.forEach((row,ri) => {
    let cx = 0.2;
    aw.forEach((w,ci) => {
      const isH = ri===0;
      s.addShape(pres.ShapeType.rect, {x:cx,y:2.38+ri*0.5,w,h:0.46,fill:{color:isH?C.navy:(ri%2===0?"F0F6FA":C.white)},line:{color:C.ltgray,pt:0.4}});
      s.addText(row[ci], {x:cx+0.04,y:2.38+ri*0.5,w:w-0.08,h:0.46,fontSize:isH?9.5:11,bold:isH,color:isH?C.white:C.gray,align:"center",valign:"middle"});
      cx+=w;
    });
  });

  // Sex & mortality note
  s.addShape(pres.ShapeType.rect, {x:5.1,y:1.98,w:4.7,h:3.25,fill:{color:C.white},line:{color:C.ltgray,pt:1}});
  s.addShape(pres.ShapeType.rect, {x:5.1,y:1.98,w:4.7,h:0.36,fill:{color:C.mid}});
  s.addText("Key Baseline Notes", {x:5.15,y:1.98,w:4.6,h:0.36,fontSize:11,bold:true,color:C.white,valign:"middle",margin:5});
  const notes = [
    "Data prospectively collected – minimises recall bias",
    "Cross-matched between SFR and SAR at individual patient level",
    "Competing risk of death accounted for in all analyses",
    "Women comprised ~67% of cohort, reflecting fracture epidemiology",
    "Mortality rate of 54.9% by 5 years highlights frailty of cohort",
    "Cannulated screws were the dominant fixation method",
  ];
  notes.forEach((n,i) => s.addText("• "+n, {x:5.2,y:2.42+i*0.46,w:4.55,h:0.42,fontSize:10.5,color:C.gray}));
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 – PRIMARY RESULTS: CONVERSION RATES
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.navy}});
  hdr(s,"Primary Results: Cumulative Conversion to Arthroplasty",C.teal);
  ftr(s);

  // Overall CIF boxes
  const cif = [
    {t:"1 Year",  pct:"6.3%",  sub:"of patients converted",    color:C.teal},
    {t:"2 Years", pct:"8.1%",  sub:"of patients converted",    color:C.orange},
    {t:"5 Years", pct:"10.1%", sub:"of patients converted",    color:C.red},
  ];
  cif.forEach((c,i) => {
    const x = 0.3 + i*3.23;
    s.addShape(pres.ShapeType.rect, {x,y:0.75,w:3.0,h:1.25,fill:{color:c.color}});
    s.addText(c.t,   {x,y:0.75,w:3.0,h:0.38,fontSize:13,bold:true,color:C.white,align:"center",valign:"middle"});
    s.addText(c.pct, {x,y:1.1, w:3.0,h:0.55,fontSize:30,bold:true,color:C.white,align:"center",valign:"middle"});
    s.addText(c.sub, {x,y:1.62,w:3.0,h:0.3, fontSize:9.5,color:C.white,align:"center"});
  });

  // Conversion by age group table
  s.addText("Conversion Rate by Age Group", {x:0.2,y:2.18,w:5.5,h:0.35,fontSize:12,bold:true,color:C.white});
  const byAge = [
    ["Age Group", "1-Year CIF", "2-Year CIF", "5-Year CIF"],
    ["60–69 yrs", "4.5%",  "6.5%",  "~11%"],
    ["70–79 yrs", "7.0%",  "9.6%",  "~12%"],
    ["≥80 yrs",   "6.1%",  "7.8%",  "~8%"],
  ];
  const bw = [1.7,1.2,1.2,1.2];
  byAge.forEach((row,ri) => {
    let cx = 0.2;
    bw.forEach((w,ci) => {
      const isH = ri===0;
      const bg = isH ? C.mid : (ri===2 ? "1A3F5C" : "162B40");
      s.addShape(pres.ShapeType.rect, {x:cx,y:2.58+ri*0.5,w,h:0.46,fill:{color:bg},line:{color:"2A4A65",pt:0.5}});
      s.addText(row[ci], {x:cx+0.03,y:2.58+ri*0.5,w:w-0.06,h:0.46,fontSize:isH?9.5:11,bold:isH,color:isH?C.gold:C.white,align:"center",valign:"middle"});
      cx+=w;
    });
  });

  // Sex & key risk
  s.addText("Risk Factors for Conversion", {x:5.7,y:2.18,w:4.1,h:0.35,fontSize:12,bold:true,color:C.white});
  const risks = [
    {label:"Female sex", val:"HR 1.49  (95% CI 1.19–1.87)", color:C.orange},
    {label:"Age 70–79", val:"Highest conversion rate group", color:C.red},
    {label:">50% conversions", val:"Occurred within 1st year", color:C.teal},
  ];
  risks.forEach((r,i) => {
    s.addShape(pres.ShapeType.rect, {x:5.7,y:2.62+i*0.9,w:4.1,h:0.82,fill:{color:C.mid},line:{color:r.color,pt:2}});
    s.addText(r.label, {x:5.8,y:2.65+i*0.9,w:3.9,h:0.3,fontSize:11,bold:true,color:r.color});
    s.addText(r.val,   {x:5.8,y:2.97+i*0.9,w:3.9,h:0.3,fontSize:11,color:C.white});
  });

  // 1-in-10 callout
  s.addShape(pres.ShapeType.rect, {x:0.2,y:5.05,w:9.6,h:0.38,fill:{color:C.gold}});
  s.addText("Key finding: 1 in 10 patients treated with IF for nondisplaced FNF required conversion to arthroplasty within 5 years. More than half of conversions occurred within year 1.", {
    x:0.25,y:5.05,w:9.5,h:0.38,fontSize:10,bold:true,color:C.navy,align:"center",valign:"middle",
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 – MORTALITY RESULTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.light}});
  hdr(s,"Mortality Findings",C.red);
  ftr(s);

  // Mortality stat boxes
  const mort = [
    {t:"1-Year Mortality",  pct:"21.3%", ci:"95% CI: 20.3–22.5%", color:C.orange},
    {t:"2-Year Mortality",  pct:"31.3%", ci:"95% CI: 30.0–32.6%", color:C.red},
    {t:"5-Year Mortality",  pct:"54.9%", ci:"95% CI: 53.1–56.7%", color:"6B1010"},
  ];
  mort.forEach((m,i) => {
    const x = 0.2 + i*3.25;
    s.addShape(pres.ShapeType.rect, {x,y:0.72,w:3.1,h:1.2,fill:{color:m.color}});
    s.addText(m.t,  {x,y:0.72,w:3.1,h:0.38,fontSize:12,bold:true,color:C.white,align:"center",valign:"middle"});
    s.addText(m.pct,{x,y:1.06,w:3.1,h:0.52,fontSize:28,bold:true,color:C.white,align:"center",valign:"middle"});
    s.addText(m.ci, {x,y:1.57,w:3.1,h:0.28,fontSize:9,color:C.white,align:"center"});
  });

  // Sex-based mortality table
  s.addText("Mortality by Sex & Timepoint", {x:0.2,y:2.06,w:5.5,h:0.35,fontSize:12,bold:true,color:C.navy});
  const mortT = [
    ["",            "1-Year", "2-Year", "5-Year"],
    ["All patients","21.3%",  "31.3%",  "54.9%"],
    ["Male",        "~28%",   "~40%",   "~64%"],
    ["Female",      "~18%",   "~27%",   "~50%"],
  ];
  const tw = [1.7,1.2,1.2,1.2];
  mortT.forEach((row,ri) => {
    let cx = 0.2;
    tw.forEach((w,ci) => {
      const isH = ri===0;
      const bg = isH ? C.navy : (ri===1 ? "F5E8E8" : (ri===2 ? "F2E0D0" : C.white));
      s.addShape(pres.ShapeType.rect, {x:cx,y:2.45+ri*0.5,w,h:0.46,fill:{color:bg},line:{color:C.ltgray,pt:0.4}});
      s.addText(row[ci], {x:cx+0.03,y:2.45+ri*0.5,w:w-0.06,h:0.46,fontSize:isH?9.5:11,bold:isH||ci===0,color:isH?C.white:C.gray,align:"center",valign:"middle"});
      cx+=w;
    });
  });

  // Male vs Female HR
  s.addShape(pres.ShapeType.rect, {x:5.7,y:2.06,w:4.1,h:2.85,fill:{color:C.white},line:{color:C.ltgray,pt:1}});
  s.addShape(pres.ShapeType.rect, {x:5.7,y:2.06,w:4.1,h:0.38,fill:{color:C.navy}});
  s.addText("Male vs. Female Mortality Risk", {x:5.75,y:2.06,w:4.0,h:0.38,fontSize:11,bold:true,color:C.white,valign:"middle",margin:4});
  const mrisk = [
    ["Adjusted 1-yr HR (Male vs Female)","1.79 (95% CI 1.61–2.00)"],
    ["Higher mortality in men","At all time points"],
    ["Competing risk noted","High mortality limits conversion in ≥80 yr group"],
  ];
  mrisk.forEach(([k,v],i) => {
    s.addText(k+":", {x:5.78,y:2.52+i*0.72,w:4.0,h:0.3,fontSize:10,bold:true,color:C.navy});
    s.addText(v,     {x:5.78,y:2.82+i*0.72,w:4.0,h:0.3,fontSize:10.5,color:C.gray});
  });

  s.addShape(pres.ShapeType.rect, {x:0.2,y:5.04,w:9.6,h:0.38,fill:{color:C.navy}});
  s.addText("Interpretation: High competing mortality (54.9% at 5 yrs) is a key confounder — especially in the ≥80 group where many do not survive to undergo conversion.", {
    x:0.25,y:5.04,w:9.5,h:0.38,fontSize:9.5,italic:true,color:C.ltgray,align:"center",valign:"middle",
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 – STRENGTHS & LIMITATIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.light}});
  hdr(s,"Critical Appraisal: Strengths & Limitations",C.gray);
  ftr(s);

  // Strengths
  s.addShape(pres.ShapeType.rect, {x:0.2,y:0.72,w:4.6,h:0.42,fill:{color:C.green}});
  s.addText("✓  Strengths", {x:0.2,y:0.72,w:4.6,h:0.42,fontSize:13,bold:true,color:C.white,valign:"middle",margin:8});
  const str = [
    "Large national registry (n=5,428) — high statistical power",
    "Prospectively collected data — reduces recall and selection bias",
    "Cross-matching two validated national registers (SFR + SAR)",
    "Competing risk analysis appropriately handles mortality",
    "Long follow-up of up to 5 years",
    "Multi-center national data — high external validity for Sweden",
    "Clinically relevant question with direct practice implications",
    "Detailed age-group stratification (60–69, 70–79, ≥80)",
  ];
  str.forEach((t,i) => s.addText("• "+t, {x:0.25,y:1.22+i*0.48,w:4.5,h:0.44,fontSize:10.5,color:C.gray}));

  // Limitations
  s.addShape(pres.ShapeType.rect, {x:5.2,y:0.72,w:4.6,h:0.42,fill:{color:C.red}});
  s.addText("✗  Limitations", {x:5.2,y:0.72,w:4.6,h:0.42,fontSize:13,bold:true,color:C.white,valign:"middle",margin:8});
  const lim = [
    "Observational design — cannot establish causation",
    "No data on fracture displacement grading (Garden subtype)",
    "No information on fixation type (screws vs. SHS) breakdown",
    "Inability to blind — inherent in registry-based studies",
    "No functional outcome scores (PROMs) recorded",
    "Swedish population — may limit generalizability globally",
    "Indications for primary arthroplasty not captured",
    "No data on surgeon volume or hospital-level variation",
  ];
  lim.forEach((t,i) => s.addText("• "+t, {x:5.25,y:1.22+i*0.48,w:4.5,h:0.44,fontSize:10.5,color:C.gray}));
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 – DISCUSSION POINTS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.light}});
  hdr(s,"Discussion Points for Journal Club",C.teal);
  ftr(s);

  const disc = [
    {
      q:"Should primary arthroplasty be considered for women aged 70–79 with nondisplaced FNF?",
      a:"This age-sex group had the highest conversion rate (9.6% at 2 yrs, HR 1.49 for female sex). Primary arthroplasty may reduce reoperations but adds upfront surgical risk.",
    },
    {
      q:"Does the 10% 5-year conversion rate justify changing current practice?",
      a:"Although 90% avoid conversion, the 10% who convert do so under worse conditions (failed hardware, pain). Early identification of high-risk patients is key.",
    },
    {
      q:"Why does the ≥80 group have a lower conversion rate than 70–79?",
      a:"Competing mortality (54.9% at 5 yrs) prevents conversion — patients die before reoperation. Competing risk analysis is essential to interpret this correctly.",
    },
    {
      q:"What are the limitations of registry data in answering this clinical question?",
      a:"No PROMs, no fracture grading detail, no fixation subtype analysis. Registry data answers 'what happened' but not 'why' or 'how well the patient did functionally'.",
    },
    {
      q:"How does this data change shared decision-making with patients?",
      a:"Patients can be counselled that ~1 in 10 will need a second operation, with risk highest in the first year and in women aged 70–79.",
    },
  ];

  disc.forEach((d,i) => {
    const y = 0.78+i*0.92;
    s.addShape(pres.ShapeType.roundRect, {x:0.2,y,w:9.6,h:0.86,fill:{color:i%2===0?C.white:"EBF5FB"},line:{color:C.teal,pt:0.8},rectRadius:0.05});
    s.addShape(pres.ShapeType.rect,      {x:0.2,y,w:0.36,h:0.86,fill:{color:C.teal}});
    s.addText((i+1).toString(), {x:0.2,y,w:0.36,h:0.86,fontSize:14,bold:true,color:C.white,align:"center",valign:"middle",margin:0});
    s.addText(d.q, {x:0.64,y:y+0.04,w:9.1,h:0.32,fontSize:10.5,bold:true,color:C.navy});
    s.addText(d.a, {x:0.64,y:y+0.38,w:9.1,h:0.42,fontSize:10,  color:C.gray});
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 – CONCLUSIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.navy}});
  s.addShape(pres.ShapeType.rect, {x:0,y:4.96,w:10,h:0.08,fill:{color:C.gold}});
  ftr(s);

  s.addText("Conclusions", {
    x:0.5,y:0.15,w:9,h:0.65,
    fontSize:26,bold:true,color:C.gold,align:"center",
  });

  const conc = [
    "1 in 10 patients (10.1%) ≥60 years treated with IF for nondisplaced FNF converted to arthroplasty within 5 years.",
    "More than half of all conversions occurred within the first postoperative year — early follow-up is critical.",
    "Women had a significantly higher risk of conversion (HR 1.49, 95% CI 1.19–1.87).",
    "Patients aged 70–79 had the highest 2-year conversion rate (9.6%) — this subgroup warrants careful consideration for primary arthroplasty.",
    "High 5-year mortality (54.9%) — particularly in men — acts as a competing risk reducing the observed conversion rate in the oldest cohort.",
    "These registry findings support further RCTs comparing IF vs. primary arthroplasty in high-risk subgroups (women, 70–79 yrs).",
  ];

  conc.forEach((c,i) => {
    const y = 0.9+i*0.72;
    s.addShape(pres.ShapeType.rect, {x:0.3,y:y+0.05,w:0.44,h:0.44,fill:{color:C.gold}});
    s.addText((i+1).toString(), {x:0.3,y:y+0.05,w:0.44,h:0.44,fontSize:14,bold:true,color:C.navy,align:"center",valign:"middle",margin:0});
    s.addText(c, {x:0.85,y,w:8.9,h:0.62,fontSize:11.5,color:C.white,valign:"middle"});
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 – TAKE-HOME MESSAGE & REFERENCE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, {x:0,y:0,w:10,h:5.625,fill:{color:C.navy}});
  s.addShape(pres.ShapeType.rect, {x:0,y:4.0,w:10,h:0.06,fill:{color:C.gold}});
  ftr(s);

  s.addText("Thank You", {x:0.5,y:0.25,w:9,h:1.0,fontSize:44,bold:true,color:C.white,align:"center",valign:"middle"});
  s.addText("Questions & Discussion", {x:0.5,y:1.3,w:9,h:0.5,fontSize:18,italic:true,color:C.teal,align:"center"});

  // Take-home box
  s.addShape(pres.ShapeType.rect, {x:0.5,y:2.0,w:9,h:1.15,fill:{color:C.teal},line:{color:C.gold,pt:2}});
  s.addText([
    {text:"Take-Home Message: ", options:{bold:true,color:C.gold}},
    {text:"One in ten elderly patients with nondisplaced femoral neck fractures treated by internal fixation will require conversion to arthroplasty within 5 years. Risk is greatest in women and in those aged 70–79. These findings support individualised treatment planning and future RCT evaluation of primary arthroplasty in high-risk subgroups.", options:{color:C.white}},
  ], {x:0.6,y:2.0,w:8.8,h:1.15,fontSize:11.5,valign:"middle"});

  // Citation
  s.addText("Citation", {x:0.5,y:3.3,w:9,h:0.32,fontSize:12,bold:true,color:C.gold});
  s.addText(
    "Lagergren J, Mukka S, Wolf O, Nauclér E, Möller M, Rogmark C. Conversion to Arthroplasty After Internal Fixation of Nondisplaced Femoral Neck Fractures: Results from a Swedish Register Cohort of 5,428 Individuals 60 Years of Age or Older. J Bone Joint Surg Am. 2023 Mar 1;105(5). doi:10.2106/JBJS.22.01035  |  PMID: 36729034",
    {x:0.5,y:3.62,w:9,h:0.65,fontSize:10,italic:true,color:C.ltgray}
  );
  s.addText("Level of Evidence: Prognostic Level III  •  Impact Factor: 4.3  •  Observational Cohort Study", {
    x:0.5,y:4.35,w:9,h:0.32,fontSize:10,color:C.gold,align:"center",
  });
}

// ── write ─────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/journal-club-lagergren/FNF_Conversion_JournalClub.pptx" })
  .then(()=>console.log("DONE"))
  .catch(e=>{console.error(e);process.exit(1);});

const pptxgen = require("pptxgenjs");
const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title  = "VLP vs EF for Distal Radial Fractures – Journal Club";

// ── Keynote-inspired palette (clean, minimal, bold accents) ─────────────
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  white:   "FFFFFF",
  offwhite:"F7F8FA",
  black:   "1A1A1A",
  charcoal:"2D3436",
  slate:   "4A5568",
  blue:    "0A5C8A",   // primary accent
  sky:     "2D9CDB",   // secondary accent
  mint:    "00897B",   // positive
  coral:   "C0392B",   // negative / caution
  amber:   "E07B00",   // highlight
  ltblue:  "EBF5FB",
  ltgray:  "E8ECF0",
  divider: "CBD5E0",
};

// ── Helpers ──────────────────────────────────────────────────────────────
function topBar(s, color) {
  s.addShape(pres.ShapeType.rect, { x:0, y:0, w:10, h:0.07, fill:{color: color||C.blue} });
}

function sectionTag(s, label, color) {
  // small pill tag top-left
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  s.addText(label.toUpperCase(), { x:0.4, y:0.22, w:2.2, h:0.32, fontSize:8.5, bold:true, color:C.white, align:"center", valign:"middle", charSpacing:1.5, margin:0 });
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  s.addText("Wretenberg et al. J Bone Joint Surg Am. 2021;103:405-414  |  Journal Club", {
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  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  // Full white bg, single bold blue stripe at bottom
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  s.addShape(pres.ShapeType.rect, { x:0,y:4.42,w:10,h:1.2, fill:{color:C.blue} });
  s.addShape(pres.ShapeType.rect, { x:0,y:4.37,w:10,h:0.08, fill:{color:C.amber} });

  // Journal tag
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  s.addText("JOURNAL CLUB", { x:0.5,y:0.38,w:2.6,h:0.34, fontSize:9, bold:true, color:C.blue, align:"center", valign:"middle", charSpacing:2, margin:0 });

  // Main title
  s.addText("Volar Locking Plate\nvs. External Fixation", {
    x:0.5, y:0.85, w:8.5, h:2.1,
    fontSize:46, bold:true, color:C.black, lineSpacingMultiple:1.1,
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  s.addText("for Displaced Extra-Articular Distal Radial Fractures", {
    x:0.5, y:2.88, w:8.5, h:0.52,
    fontSize:18, color:C.slate, italic:false,
  });

  s.addText("A Multicenter Randomized Controlled Trial", {
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    fontSize:13, color:C.sky, italic:true,
  });

  // Bottom bar content
  s.addText("Wretenberg et al.", { x:0.5, y:4.52, w:4, h:0.36, fontSize:13, bold:true, color:C.white });
  s.addText("J Bone Joint Surg Am. 2021;103:405-414", { x:0.5, y:4.86, w:5, h:0.26, fontSize:10, color:"B0CCE0" });
  s.addText("Level I Evidence  •  RCT  •  JBJS.20.00275", { x:5.5, y:4.55, w:4, h:0.52, fontSize:11, color:C.amber, align:"right", valign:"middle" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 – BACKGROUND
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  topBar(s);
  sectionTag(s,"Background");
  slideTitle(s,"Background","Why was this study needed?");
  divLine(s);
  ftr(s);

  const pts = [
    { icon:"01", head:"Epidemiology",       body:"Distal radial fractures are among the most common fractures in adults, particularly in active working-age individuals." },
    { icon:"02", head:"Treatment options",  body:"Both Volar Locking Plate (VLP) and External Fixation (EF) are established surgical treatments for displaced extra-articular types." },
    { icon:"03", head:"Conflicting data",   body:"Earlier small RCTs yielded conflicting results due to heterogeneous populations, varied outcome measures, and methodological limitations." },
    { icon:"04", head:"Evidence gap",       body:"No sufficiently powered, well-designed RCT existed to definitively guide surgical decision-making for OTA/AO type A3 fractures." },
  ];

  pts.forEach((p, i) => {
    const y = 1.72 + i*0.9;
    s.addShape(pres.ShapeType.roundRect, { x:0.4,y,w:0.52,h:0.52, fill:{color:C.blue}, rectRadius:0.26 });
    s.addText(p.icon, { x:0.4,y,w:0.52,h:0.52, fontSize:11, bold:true, color:C.white, align:"center", valign:"middle", margin:0 });
    s.addText(p.head, { x:1.05,y:y+0.02, w:8.5,h:0.28, fontSize:12.5, bold:true, color:C.black });
    s.addText(p.body, { x:1.05,y:y+0.3,  w:8.5,h:0.38, fontSize:11,   color:C.slate });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 – PICO / AIM
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.offwhite} });
  topBar(s, C.mint);
  sectionTag(s,"Research Question", C.mint);
  slideTitle(s,"PICO Framework");
  divLine(s);
  ftr(s);

  // Large PICO cards
  const pico = [
    { letter:"P", label:"Population",    color:C.blue,  body:"Adults 18–70 years with displaced extra-articular distal radial fracture\n(OTA/AO type A3)" },
    { letter:"I", label:"Intervention",  color:C.mint,  body:"Volar Locking Plate (VLP) fixation" },
    { letter:"C", label:"Comparator",    color:C.coral, body:"External Fixation (EF)" },
    { letter:"O", label:"Outcomes",      color:C.amber, body:"PRWHE score, QuickDASH, ROM, pain (VAS), radiographic parameters, complications\nat 6 wk, 3 mo, 1 yr" },
  ];

  pico.forEach((p,i) => {
    const x = 0.22 + i*2.42;
    s.addShape(pres.ShapeType.rect, { x,y:1.72,w:2.28,h:3.2, fill:{color:C.white}, line:{color:C.ltgray,pt:1} });
    s.addShape(pres.ShapeType.rect, { x,y:1.72,w:2.28,h:0.7, fill:{color:p.color} });
    s.addText(p.letter, { x,y:1.72,w:2.28,h:0.7, fontSize:28, bold:true, color:C.white, align:"center", valign:"middle" });
    s.addText(p.label,  { x:x+0.1,y:2.5,w:2.1,h:0.38, fontSize:11, bold:true, color:p.color });
    s.addText(p.body,   { x:x+0.1,y:2.9,w:2.1,h:1.9,  fontSize:10.5, color:C.charcoal, lineSpacingMultiple:1.3 });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 – METHODS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  topBar(s, C.sky);
  sectionTag(s,"Methods", C.sky);
  slideTitle(s,"Study Design & Methods");
  divLine(s);
  ftr(s);

  // Three columns
  const cols = [
    {
      head:"Study Design",
      color:C.blue,
      rows:["Multicenter RCT","2 parallel treatment arms","3 centers in Norway","Block randomization","NCT01904084 (ClinicalTrials.gov)"],
    },
    {
      head:"Inclusion Criteria",
      color:C.mint,
      rows:["Age 18–70 years","Displaced extra-articular DRF","OTA/AO type A3","Requires operative fixation"],
    },
    {
      head:"Exclusion Criteria",
      color:C.coral,
      rows:["Intra-articular fractures","Open fractures","Bilateral fractures","Dementia / psychiatric disorders","Unable to comply with follow-up"],
    },
  ];

  cols.forEach((col,i) => {
    const x = 0.25 + i*3.25;
    s.addShape(pres.ShapeType.rect, { x,y:1.7,w:3.1,h:3.6, fill:{color:C.offwhite}, line:{color:C.ltgray,pt:1} });
    s.addShape(pres.ShapeType.rect, { x,y:1.7,w:3.1,h:0.45, fill:{color:col.color} });
    s.addText(col.head, { x:x+0.08,y:1.7,w:2.95,h:0.45, fontSize:12, bold:true, color:C.white, valign:"middle", margin:0 });
    col.rows.forEach((row,j) => {
      s.addShape(pres.ShapeType.line, { x:x+0.12,y:2.28+j*0.62,w:2.86,h:0, line:{color:C.ltgray,pt:0.5} });
      s.addText("— "+row, { x:x+0.12,y:2.32+j*0.62,w:2.86,h:0.52, fontSize:11, color:C.charcoal, valign:"middle" });
    });
  });

  // Sample size strip
  s.addShape(pres.ShapeType.rect, { x:0.25,y:5.08,w:9.5,h:0.3, fill:{color:C.ltblue} });
  s.addText("Sample size: n=160 planned (α=0.05, 80% power, SD=21, MID=11.5 pts)  →  Final: 75 VLP + 75 EF = 150 randomised", {
    x:0.3,y:5.08,w:9.4,h:0.3, fontSize:9.5, color:C.blue, align:"center", valign:"middle",
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 – PRIMARY OUTCOME (PRWHE)
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  topBar(s, C.amber);
  sectionTag(s,"Results – Primary Outcome", C.amber);
  slideTitle(s,"PRWHE Score","Patient-Rated Wrist/Hand Evaluation  •  Range 0–100  •  Lower = Better  •  MID = 11.5 pts");
  divLine(s);
  ftr(s);

  // Score table
  const rows = [
    ["Timepoint",   "VLP (mean ± SD)", "EF (mean ± SD)", "Δ",       "p-value"],
    ["6 Weeks",     "30 ± 21",          "46 ± 22",         "−16 pts", "< 0.001"],
    ["3 Months",    "15 ± 15",          "21 ± 18",         "−6 pts",  "0.016"],
    ["1 Year",      "8 ± 12",           "11 ± 13",         "−3 pts",  "0.13 (NS)"],
  ];
  const cw = [1.8, 2.1, 2.1, 1.2, 1.5];
  rows.forEach((row, ri) => {
    let cx = 0.38;
    cw.forEach((w, ci) => {
      const isH = ri === 0;
      const isLast = ri === 3;
      const pCol = ci === 4;
      let bg = isH ? C.black : (ri%2===0 ? C.offwhite : C.white);
      let fg = isH ? C.white : C.charcoal;
      if (pCol && !isH) fg = isLast ? C.slate : C.mint;
      if (pCol && isLast && !isH) bg = "FFF8E7";
      s.addShape(pres.ShapeType.rect, { x:cx,y:1.72+ri*0.62,w,h:0.58, fill:{color:bg}, line:{color:C.ltgray,pt:0.5} });
      s.addText(row[ci], { x:cx+0.05,y:1.72+ri*0.62,w:w-0.1,h:0.58, fontSize:isH?10:12, bold:isH||pCol, color:fg, align:"center", valign:"middle" });
      cx += w;
    });
  });

  // Full recovery callout
  s.addShape(pres.ShapeType.rect, { x:0.38,y:4.22,w:9.25,h:0.62, fill:{color:C.ltblue}, line:{color:C.sky,pt:1.5} });
  s.addText([
    {text:"Full Recovery (PRWHE ≤10):  ", options:{bold:true,color:C.blue}},
    {text:"6 wk — VLP 23% vs EF 6%   ", options:{color:C.charcoal}},
    {text:"3 mo — VLP 58% vs EF 47%   ", options:{color:C.charcoal}},
    {text:"1 yr — VLP 81% vs EF 79%", options:{color:C.charcoal}},
  ], { x:0.45,y:4.22,w:9.1,h:0.62, fontSize:11.5, valign:"middle" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 – SECONDARY OUTCOMES (ROM + QuickDASH + Pain)
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  topBar(s, C.sky);
  sectionTag(s,"Results – Secondary Outcomes", C.sky);
  slideTitle(s,"Range of Motion, QuickDASH & Pain");
  divLine(s);
  ftr(s);

  // ROM table (left)
  s.addText("Range of Motion (% of uninjured side)", { x:0.38,y:1.66,w:5.4,h:0.32, fontSize:11, bold:true, color:C.blue });
  const rom = [
    ["Motion",     "VLP 6wk","EF 6wk","p","VLP 1yr","EF 1yr","p"],
    ["Flexion",    "68.6%",  "54.8%", "<0.001","97%","94%","0.66"],
    ["Extension",  "62.0%",  "3.8%",  "<0.001","93%","91%","0.013"],
    ["Supination", "74.1%",  "42.5%", "<0.001","99%","93%","0.03"],
    ["Grip Str.",  "~69%",   "~51%",  "<0.001","97%","95%","0.70"],
  ];
  const rw = [1.05,0.62,0.62,0.58,0.62,0.62,0.58];
  rom.forEach((row,ri) => {
    let cx = 0.38;
    rw.forEach((w,ci) => {
      const isH = ri===0;
      const bg = isH ? C.charcoal : (ri%2===0 ? C.offwhite : C.white);
      s.addShape(pres.ShapeType.rect, {x:cx,y:2.02+ri*0.47,w,h:0.43,fill:{color:bg},line:{color:C.ltgray,pt:0.4}});
      s.addText(row[ci], {x:cx+0.02,y:2.02+ri*0.47,w:w-0.04,h:0.43,fontSize:isH?8:9.5,bold:isH,color:isH?C.white:C.charcoal,align:"center",valign:"middle"});
      cx+=w;
    });
  });

  // QuickDASH (right)
  s.addText("QuickDASH  (lower = better)", { x:5.8,y:1.66,w:3.8,h:0.32, fontSize:11, bold:true, color:C.blue });
  const qd = [
    ["Timepoint","VLP","EF","p"],
    ["6 Weeks",  "27", "45","< 0.001"],
    ["3 Months", "15", "22","0.023"],
    ["1 Year",   "9",  "12","0.36 (NS)"],
  ];
  const qw = [1.3,0.75,0.75,1.0];
  qd.forEach((row,ri) => {
    let cx = 5.8;
    qw.forEach((w,ci) => {
      const isH = ri===0;
      const bg = isH ? C.charcoal : (ri%2===0 ? C.offwhite : C.white);
      s.addShape(pres.ShapeType.rect, {x:cx,y:2.02+ri*0.47,w,h:0.43,fill:{color:bg},line:{color:C.ltgray,pt:0.4}});
      s.addText(row[ci], {x:cx+0.02,y:2.02+ri*0.47,w:w-0.04,h:0.43,fontSize:isH?8:9.5,bold:isH,color:isH?C.white:C.charcoal,align:"center",valign:"middle"});
      cx+=w;
    });
  });

  // Pain note
  s.addShape(pres.ShapeType.rect, { x:0.38,y:4.42,w:9.25,h:0.55, fill:{color:"FFF3E0"}, line:{color:C.amber,pt:1} });
  s.addText([
    {text:"Pain (VAS): ", options:{bold:true,color:C.amber}},
    {text:"No significant difference at rest at any timepoint. VLP had significantly less pain during activity at 3 months and 1 year.", options:{color:C.charcoal}},
  ], { x:0.48,y:4.42,w:9.1,h:0.55, fontSize:11, valign:"middle" });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 – COMPLICATIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  topBar(s, C.coral);
  sectionTag(s,"Results – Complications", C.coral);
  slideTitle(s,"Complications");
  divLine(s);
  ftr(s);

  // Major table
  s.addText("Major Complications", { x:0.38,y:1.65,w:5.0,h:0.3, fontSize:11, bold:true, color:C.coral });
  const maj = [
    ["Complication",        "VLP","EF","p"],
    ["CRPS",                "4%", "11%","0.14"],
    ["Carpal Tunnel Synd.", "7%", "4%", "0.49"],
    ["Prolonged wrist pain","3%", "3%", "1.0"],
    ["Deep infection",      "1%", "0%", "1.0"],
    ["Suboptimal osteosyn.","1%", "4%", "0.62"],
    ["Plate removal",       "7%", "—",  "0.025"],
    ["Total Major",         "23%","25%","0.83"],
  ];
  const mw = [2.0,0.8,0.8,0.85];
  maj.forEach((row,ri) => {
    let cx = 0.38;
    mw.forEach((w,ci) => {
      const isH = ri===0; const isT = ri===maj.length-1;
      const bg = isH ? C.charcoal : isT ? C.ltblue : (ri%2===0 ? C.offwhite : C.white);
      s.addShape(pres.ShapeType.rect, {x:cx,y:1.98+ri*0.42,w,h:0.38,fill:{color:bg},line:{color:C.ltgray,pt:0.4}});
      s.addText(row[ci], {x:cx+0.04,y:1.98+ri*0.42,w:w-0.08,h:0.38,fontSize:isH?8.5:10,bold:isH||isT,color:isH?C.white:C.charcoal,align:ci===0?"left":"center",valign:"middle"});
      cx+=w;
    });
  });

  // Minor table
  s.addText("Minor Complications", { x:5.5,y:1.65,w:4.1,h:0.3, fontSize:11, bold:true, color:C.slate });
  const min = [
    ["Complication",     "VLP","EF","p"],
    ["Superficial infxn","1%", "10%","0.063"],
    ["Scar tissue",      "7%", "8%", "0.83"],
    ["Paresthesia",      "6%", "7%", "1.0"],
    ["Neuropathy",       "3%", "3%", "1.0"],
    ["Total Minor",      "25%","32%","0.36"],
  ];
  const mnw = [1.6,0.75,0.75,0.8];
  min.forEach((row,ri) => {
    let cx = 5.5;
    mnw.forEach((w,ci) => {
      const isH = ri===0; const isT = ri===min.length-1;
      const bg = isH ? C.charcoal : isT ? C.ltblue : (ri%2===0 ? C.offwhite : C.white);
      s.addShape(pres.ShapeType.rect, {x:cx,y:1.98+ri*0.42,w,h:0.38,fill:{color:bg},line:{color:C.ltgray,pt:0.4}});
      s.addText(row[ci], {x:cx+0.04,y:1.98+ri*0.42,w:w-0.08,h:0.38,fontSize:isH?8.5:10,bold:isH||isT,color:isH?C.white:C.charcoal,align:ci===0?"left":"center",valign:"middle"});
      cx+=w;
    });
  });

  // Note strip
  s.addShape(pres.ShapeType.rect, { x:0.38,y:5.06,w:9.25,h:0.32, fill:{color:"FEF0EF"}, line:{color:C.coral,pt:0.8} });
  s.addText("Plate removal unique to VLP (7%). EF trended toward more CRPS (11%) and superficial infection (10%). No significant difference in overall complication rate (p=0.83 major / p=0.36 minor).", {
    x:0.45,y:5.06,w:9.1,h:0.32, fontSize:9, italic:true, color:C.coral, valign:"middle",
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 – DISCUSSION
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  topBar(s, C.mint);
  sectionTag(s,"Discussion", C.mint);
  slideTitle(s,"Discussion & Critical Appraisal");
  divLine(s);
  ftr(s);

  // Two-column: strengths + limitations
  s.addText("Strengths", { x:0.38,y:1.68,w:4.4,h:0.3, fontSize:11.5, bold:true, color:C.mint });
  s.addText("Limitations", { x:5.35,y:1.68,w:4.3,h:0.3, fontSize:11.5, bold:true, color:C.coral });
  s.addShape(pres.ShapeType.line, { x:4.95,y:1.68,w:0,h:3.6, line:{color:C.ltgray,pt:1} });

  const str = [
    "Level I RCT — highest therapeutic evidence",
    "Multicenter design (3 Norwegian centres)",
    "Block randomisation by independent biostatistician",
    "ITT analysis — preserves allocation integrity",
    "Validated PROMs: PRWHE + QuickDASH",
    "3 timepoints: 6 wk, 3 mo, 1 yr",
    "Blinded radiographic assessment",
    "Pre-specified power calculation",
  ];
  const lim = [
    "Follow-up limited to 1 year — no long-term data",
    "Only A3 (extra-articular) fractures — limited generalisability",
    "Blinding of patients/surgeons not possible",
    "Norwegian cohort — demographic homogeneity",
    "Surgeon experience/volume not standardised",
    "No cost-effectiveness analysis",
    "Rehab protocols not fully standardised",
  ];
  str.forEach((t,i) => {
    s.addShape(pres.ShapeType.roundRect, { x:0.38,y:2.02+i*0.44,w:0.26,h:0.26, fill:{color:C.mint}, rectRadius:0.13 });
    s.addText(t, { x:0.72,y:2.02+i*0.44,w:4.12,h:0.38, fontSize:10.5, color:C.charcoal });
  });
  lim.forEach((t,i) => {
    s.addShape(pres.ShapeType.roundRect, { x:5.35,y:2.02+i*0.44,w:0.26,h:0.26, fill:{color:C.coral}, rectRadius:0.13 });
    s.addText(t, { x:5.7,y:2.02+i*0.44,w:3.9,h:0.38, fontSize:10.5, color:C.charcoal });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 – DISCUSSION QUESTIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.offwhite} });
  topBar(s, C.blue);
  sectionTag(s,"Discussion Questions", C.blue);
  slideTitle(s,"Points for Journal Club Debate");
  divLine(s);
  ftr(s);

  const qs = [
    { q:"Is 1-year follow-up sufficient?", a:"DRF may continue to remodel. Longer data needed for arthritic change, implant failure, or late CRPS." },
    { q:"Does faster recovery justify higher VLP cost?", a:"Earlier return-to-work in young patients may offset hardware cost, but health-economic data are absent." },
    { q:"Can results be extrapolated to intra-articular fractures?", a:"Study excluded intra-articular types — VLP advantage may be amplified where precision reduction is critical." },
    { q:"7% plate removal in VLP — clinically relevant?", a:"EF avoids this but trends toward more CRPS (11%) and superficial infection (10%). Risk-benefit differs by patient." },
    { q:"Impact of surgeon learning curve?", a:"VLP demands more technical skill. Multicenter design partially accounts for this, but volume data were not captured." },
  ];

  qs.forEach((q,i) => {
    const y = 1.72 + i*0.76;
    s.addShape(pres.ShapeType.rect, { x:0.38,y,w:9.25,h:0.7, fill:{color:C.white}, line:{color:C.ltgray,pt:1} });
    s.addShape(pres.ShapeType.rect, { x:0.38,y,w:0.38,h:0.7, fill:{color:C.blue} });
    s.addText((i+1).toString(), { x:0.38,y,w:0.38,h:0.7, fontSize:13,bold:true,color:C.white,align:"center",valign:"middle",margin:0 });
    s.addText(q.q, { x:0.84,y:y+0.04,w:8.7,h:0.28, fontSize:11,bold:true,color:C.black });
    s.addText(q.a, { x:0.84,y:y+0.34,w:8.7,h:0.3,  fontSize:10,color:C.slate });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 – CONCLUSION
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.black} });
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:0.07,  fill:{color:C.amber} });
  ftr(s);

  s.addText("Conclusions", { x:0.5,y:0.2,w:9,h:0.65, fontSize:26,bold:true,color:C.white,align:"center" });
  s.addShape(pres.ShapeType.line, { x:0.5,y:0.85,w:9,h:0, line:{color:"333333",pt:1} });

  const conc = [
    "VLP provides significantly faster functional recovery (PRWHE, QuickDASH, ROM) at 6 weeks and 3 months compared to EF.",
    "At 1 year, no statistically significant difference in PRWHE or QuickDASH scores (p=0.13 and p=0.36).",
    "VLP maintains better wrist extension and supination throughout follow-up; extension difference persists at 1 year (p=0.013).",
    "Complication profiles differ: VLP — 7% plate removal; EF — trends toward more CRPS (11%) and superficial infection (10%).",
    "VLP should be considered the preferred treatment for OTA/AO A3 distal radial fractures, especially when early return to function matters.",
  ];

  conc.forEach((c,i) => {
    const y = 1.0+i*0.86;
    s.addShape(pres.ShapeType.rect, { x:0.4,y:y+0.14,w:0.38,h:0.38, fill:{color:C.amber} });
    s.addText((i+1).toString(), { x:0.4,y:y+0.14,w:0.38,h:0.38, fontSize:13,bold:true,color:C.black,align:"center",valign:"middle",margin:0 });
    s.addText(c, { x:0.9,y,w:8.7,h:0.72, fontSize:12.5,color:C.white,valign:"middle" });
  });
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 – THANK YOU / REFERENCE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:5.625, fill:{color:C.white} });
  s.addShape(pres.ShapeType.rect, { x:0,y:0,w:10,h:0.07,  fill:{color:C.blue} });
  s.addShape(pres.ShapeType.rect, { x:0,y:4.5,w:10,h:1.12,fill:{color:C.offwhite} });
  ftr(s);

  s.addText("Thank You", {
    x:0.5,y:0.55,w:9,h:2.0,
    fontSize:64,bold:true,color:C.black,align:"center",valign:"middle",
  });
  s.addText("Questions & Discussion", {
    x:0.5,y:2.65,w:9,h:0.55,
    fontSize:20,color:C.slate,italic:true,align:"center",
  });
  s.addShape(pres.ShapeType.line, { x:0.5,y:3.32,w:9,h:0, line:{color:C.ltgray,pt:1} });

  s.addText("Reference", { x:0.5,y:3.42,w:9,h:0.3, fontSize:10,bold:true,color:C.blue });
  s.addText(
    "Wretenberg P, et al. Volar Locking Plate Versus External Fixation for Displaced Extra-Articular Distal Radial Fractures: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2021;103(5):405-414. doi:10.2106/JBJS.20.00275  |  PMID: —  |  Level of Evidence: Therapeutic Level I",
    { x:0.5,y:3.75,w:9,h:0.65, fontSize:10, color:C.slate, italic:true, lineSpacingMultiple:1.3 }
  );
  s.addText("Impact Factor 4.3  •  RCT  •  NCT01904084", {
    x:0.5,y:4.55,w:9,h:0.32, fontSize:10,color:C.blue,align:"center",
  });
}

// ── write ─────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/journal-club-keynote/VLP_vs_EF_Keynote_Style.pptx" })
  .then(()=>console.log("DONE"))
  .catch(e=>{console.error(e);process.exit(1);});