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metabolic response to injury ERAS overview surgical stress response

~/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51

"surgical stress" AND metabolism

mkdir -p "/tmp/workspace/metabolic-response-revision/src" "/tmp/workspace/metabolic-response-revision/output" "/tmp/workspace/metabolic-response-revision/assets" && python -c "from pptx import Presentation; from pathlib import Path for f in [Path('/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/Blue and Teal Modern Surgical Presentation.pptx'),Path('/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/Bailey_Metabolic_Response_to_Injury.pptx')]: p=Presentation(str(f)); print('FILE',f.name,'slides',len(p.slides),'size',p.slide_width,p.slide_height) for i,s in enumerate(p.slides,1): texts=[] for sh in s.shapes: if sh.has_text_frame and sh.text.strip(): texts.append(sh.text.replace('\\n',' | ')) print(i, ' || '.join(texts)[:1000]) "

cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2485.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2486.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2487.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2488.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2489.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2490.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2491.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && cp "/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/IMG_2492.jpg" "/tmp/workspace/metabolic-response-revision/assets/" && python - <<'PY' from PIL import Image from pathlib import Path for p in sorted(Path('/tmp/workspace/metabolic-response-revision/assets').glob('*.jpg')): im=Image.open(p); print(p.name, im.size) PY

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/src/build.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from PIL import Image from io import BytesIO OUT='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Revised.pptx' AS='/tmp/workspace/metabolic-response-revision/assets' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # palette NAVY=RGBColor(22,47,62); TEAL=RGBColor(35,124,129); SAGE=RGBColor(116,153,135); CORAL=RGBColor(204,112,92) CREAM=RGBColor(248,245,239); INK=RGBColor(35,46,53); MUTED=RGBColor(103,113,115); PALE=RGBColor(229,239,234); GOLD=RGBColor(209,161,88); WHITE=RGBColor(255,255,255) def rect(s,x,y,w,h,color, radius=False, line=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x), Inches(y), Inches(w), Inches(h)) sh.fill.solid(); sh.fill.fore_color.rgb=color sh.line.color.rgb=line if line else color if radius: sh.adjustments[0]=0.12 return sh def text(s,txt,x,y,w,h,sz=20,color=INK,bold=False,font='Aptos',align=PP_ALIGN.LEFT, valign=MSO_ANCHOR.TOP, italic=False): box=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=box.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(0.03); tf.margin_top=tf.margin_bottom=Inches(0.02); tf.vertical_anchor=valign for i,line in enumerate(txt.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=line; p.alignment=align p.space_after=Pt(2); p.font.name=font; p.font.size=Pt(sz); p.font.bold=bold; p.font.italic=italic; p.font.color.rgb=color return box def title(s,n,heading,kicker=None): text(s,f'{n:02d}',0.5,0.34,0.48,0.25,10,TEAL,True,align=PP_ALIGN.CENTER) rect(s,0.55,0.62,0.35,0.04,TEAL) text(s,heading,1.05,0.28,11.5,0.58,25,NAVY,True) if kicker: text(s,kicker,1.07,0.89,11.4,0.30,10,MUTED) rect(s,0.55,7.14,12.23,0.015,RGBColor(211,218,215)) def base(n,h,k=None): s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,CREAM); title(s,n,h,k); return s def add_picture_cover(s, fn,x,y,w,h): im=Image.open(f'{AS}/{fn}'); iw,ih=im.size; ar=iw/ih; tar=w/h # crop source for cover if ar>tar: nw=int(ih*tar); left=(iw-nw)//2; im=im.crop((left,0,left+nw,ih)) else: nh=int(iw/tar); top=(ih-nh)//2; im=im.crop((0,top,iw,top+nh)) buf=BytesIO(); im.save(buf,format='PNG'); buf.seek(0) s.shapes.add_picture(buf, Inches(x), Inches(y), width=Inches(w), height=Inches(h)) return rect(s,x,y,w,h,RGBColor(0,0,0)) def image(s,fn,x,y,w,h,caption=None): # white frame then image contained to preserve labels rect(s,x-0.05,y-0.05,w+0.1,h+0.1,WHITE,True,line=RGBColor(218,218,212)) im=Image.open(f'{AS}/{fn}'); iw,ih=im.size; ar=iw/ih if w/h>ar: ph=h; pw=h*ar; px=x+(w-pw)/2; py=y else: pw=w; ph=w/ar; px=x; py=y+(h-ph)/2 s.shapes.add_picture(f'{AS}/{fn}',Inches(px),Inches(py),width=Inches(pw),height=Inches(ph)) if caption:text(s,caption,x,y+h+0.08,w,0.25,8,MUTED,italic=True) def bullet(s,heading,items,x,y,w): text(s,heading,x,y,w,0.32,13,TEAL,True) yy=y+0.43 for it in items: text(s,'•',x,yy,0.25,0.28,16,CORAL,True) text(s,it,x+0.27,yy,w-0.27,0.52,14,INK) yy+=0.67 def pill(s,label,x,y,w,color=PALE): rect(s,x,y,w,0.38,color,True); text(s,label,x+0.10,y+0.08,w-0.2,0.18,10,NAVY,True,align=PP_ALIGN.CENTER) #1 s=prs.slides.add_slide(blank); rect(s,0,0,13.333,7.5,NAVY); rect(s,0,0,5.1,7.5,TEAL); rect(s,0.62,0.72,1.9,0.34,GOLD,True); text(s,'BAILEY & LOVE | SURGERY',0.76,0.81,1.6,0.15,8,NAVY,True,align=PP_ALIGN.CENTER) text(s,'Metabolic\nresponse\nto injury',0.65,1.55,4.0,2.25,31,WHITE,True); text(s,'How the body moves from acute stress to recovery',0.68,4.12,3.85,0.55,14,RGBColor(232,248,245)); text(s,'A visual, exam-focused overview',0.68,6.37,2.9,0.22,10,RGBColor(208,239,235),italic=True) add_picture_cover(s,'IMG_2486.jpg',5.1,0,8.233,7.5); rect(s,5.1,0,8.233,7.5,RGBColor(0,0,0)); s.shapes[-1].fill.transparency=55 text(s,'Homeostasis • stress response • recovery',5.55,6.56,6.7,0.35,15,WHITE,True) #2 s=base(2,'Start with the big picture','Injury disrupts homeostasis. The response is adaptive - until it is excessive or prolonged.') rect(s,0.7,1.55,11.9,1.02,PALE,True); text(s,'Surgical practice aims to limit metabolic stress and restore the conditions for healing.',1.05,1.88,11.1,0.34,20,NAVY,True,align=PP_ALIGN.CENTER) for x,head,body,co in [(0.9,'HOMEOSTASIS','Stable internal environment',SAGE),(4.72,'STRESSOR','Surgery • trauma • sepsis',CORAL),(8.54,'RECOVERY','Repair and restoration',TEAL)]: rect(s,x,3.45,3.0,1.35,WHITE,True,line=RGBColor(220,225,222)); rect(s,x,3.45,3.0,0.14,co); text(s,head,x+.28,3.75,2.5,.22,11,co,True); text(s,body,x+.28,4.12,2.5,.30,15,INK) text(s,'→',3.98,3.84,.45,.25,24,CORAL,True); text(s,'→',7.80,3.84,.45,.25,24,CORAL,True) text(s,'Learning objectives',0.95,5.58,2.7,.28,13,TEAL,True); text(s,'Classical concepts of homeostasis | Metabolic changes after injury | Physiological and biochemical recovery',0.95,6.02,11.25,.40,15,INK) #3 s=base(3,'The response is graded','Greater injury produces a larger and more sustained metabolic response.') image(s,'IMG_2485.jpg',0.78,1.36,5.1,4.98,'Figure adapted from supplied Bailey & Love page') bullet(s,'Read the curves',["Minor trauma: a modest, shorter-lived rise in metabolic rate and nitrogen loss.","Major trauma: greater hypermetabolism, catabolism and prolonged recovery.","Starvation lowers metabolic rate but compounds loss of body stores."],6.42,1.65,5.6) rect(s,6.42,5.44,5.55,.70,RGBColor(248,230,221),True); text(s,'Clinical takeaway: severity + duration of injury determine the metabolic burden.',6.72,5.68,4.98,.22,12,NAVY,True,align=PP_ALIGN.CENTER) #4 s=base(4,'Mediators of the metabolic response','The neuroendocrine system and innate immune system act together in the first 24-48 hours.') image(s,'IMG_2486.jpg',0.75,1.32,7.05,4.23,'Integrated response to surgical injury - supplied figure') for y,h,b in [(1.50,'NEUROENDOCRINE','ACTH, cortisol, catecholamines, glucagon and GH rise.'),(2.82,'INFLAMMATORY','IL-1, IL-6 and TNF-α amplify the response.'),(4.14,'METABOLIC EFFECT','Lipolysis, gluconeogenesis and proteolysis increase; insulin falls.')]: rect(s,8.27,y,3.85,0.94,WHITE,True,line=RGBColor(220,225,222)); text(s,h,8.52,y+.20,3.3,.18,10,TEAL,True); text(s,b,8.52,y+.46,3.25,.34,12,INK) #5 s=base(5,'Integrated response: injury to metabolism','Afferent signals, hormones and cytokines redirect fuel towards survival, immunity and repair.') image(s,'IMG_2486.jpg',0.78,1.32,6.45,3.87,'Use this diagram to follow the pathways from injury to metabolic effects') text(s,'WHAT CHANGES?',7.80,1.45,3.2,.23,12,TEAL,True) for i,(h,b) in enumerate([('Fuel','Adipocyte lipolysis ↑'),('Glucose','Hepatic gluconeogenesis ↑'),('Muscle','Protein degradation ↑'),('Temperature','Pyrexia + hypermetabolism')]): y=1.93+i*.77; rect(s,7.82,y,4.35,.57,WHITE,True,line=RGBColor(221,224,220)); text(s,h,8.03,y+.16,1.0,.18,11,CORAL,True); text(s,b,9.08,y+.16,2.8,.18,11,INK) rect(s,.84,5.78,11.30,.66,NAVY,True); text(s,'The response supports immediate survival, but prolonged activation drives tissue loss and complications.',1.12,5.99,10.72,.22,13,WHITE,True,align=PP_ALIGN.CENTER) #6 s=base(6,'Systemic inflammation after major injury','The response needs balance: proinflammatory activation followed by counter-regulation.') rect(s,.82,1.42,5.55,4.35,WHITE,True,line=RGBColor(220,225,222)); rect(s,6.95,1.42,5.55,4.35,WHITE,True,line=RGBColor(220,225,222)); text(s,'1. INITIAL ACTIVATION',1.15,1.78,4.8,.25,13,CORAL,True); bullet(s,'', ['IL-1, IL-6 and TNF-α rise early.','Cytokines and acute-phase mediators amplify the response.','An excessive response can become self-perpetuating.'],1.15,2.18,4.8) text(s,'2. COUNTER-REGULATION',7.27,1.78,4.8,.25,13,TEAL,True); bullet(s,'', ['Receptor antagonists and soluble receptors increase.','Pro- and anti-inflammatory activity must remain balanced.','Persistent imbalance contributes to complications.'],7.27,2.18,4.8) rect(s,5.86,3.13,1.60,.62,GOLD,True); text(s,'BALANCE',6.02,3.34,1.28,.18,11,NAVY,True,align=PP_ALIGN.CENTER); text(s,'Cytokines, cortisol, catecholamines and immune pathways form one interacting system.',1.05,6.18,11.2,.28,14,NAVY,True,align=PP_ALIGN.CENTER) #7 s=base(7,'The ebb-flow-recovery model','A practical timeline of the metabolic response after significant injury.') rect(s,1.0,2.68,10.95,.12,RGBColor(196,206,201)); for x,co,phase,time,desc in [(1.15,CORAL,'EBB','Hours','Shock • low metabolic rate\nhypovolaemia • hypothermia'),(4.72,GOLD,'FLOW','Days','Hypermetabolism • pyrexia\ncatabolism • O₂ consumption ↑'),(8.28,TEAL,'RECOVERY','Weeks','Anabolism and repair\nbody stores restored')]: rect(s,x,2.15,2.36,.95,co,True); text(s,phase,x+.13,2.38,2.1,.20,17,WHITE,True,align=PP_ALIGN.CENTER); text(s,time,x+.13,3.36,2.1,.20,12,co,True,align=PP_ALIGN.CENTER); text(s,desc,x+.05,3.77,2.28,.66,12,INK,align=PP_ALIGN.CENTER) text(s,'At about 24-48 hours, the early ebb phase gives way to a catabolic flow phase. Recovery may take weeks.',1.25,5.63,10.85,.30,16,NAVY,True,align=PP_ALIGN.CENTER) #8 s=base(8,'Fuel is redirected from peripheral to central tissues','Muscle, adipose tissue and skin provide amino acids, especially glutamine and alanine.') image(s,'IMG_2487.jpg',.85,1.45,6.0,3.68,'Peripheral tissue amino acids support liver, immunity and wound healing') rect(s,7.38,1.53,4.55,3.22,WHITE,True,line=RGBColor(220,225,222)); text(s,'KEY CATABOLIC ELEMENTS',7.72,1.83,3.85,.22,12,TEAL,True) for i,t in enumerate(['Hypermetabolism: energy expenditure and oxygen consumption ↑','Skeletal muscle: net protein catabolism and amino-acid release','Acute phase: hepatic protein synthesis is reprioritised']): text(s,'0'+str(i+1),7.72,2.32+i*.69,.35,.22,11,CORAL,True); text(s,t,8.20,2.27+i*.69,3.30,.47,12,INK) #9 s=base(9,'Skeletal muscle protein loss','In injury, protein breakdown exceeds synthesis, leading to net muscle loss.') image(s,'IMG_2488.jpg',.72,1.36,6.65,3.18,'Ubiquitin-proteasome pathway for myofibrillar protein degradation') rect(s,7.88,1.49,4.18,3.01,PALE,True); text(s,'CLINICAL CONSEQUENCES',8.18,1.82,3.5,.22,12,TEAL,True); text(s,'• Muscle wasting\n• Reduced function\n• Slower rehabilitation\n• Worse quality of life',8.18,2.26,3.25,1.50,16,INK) text(s,'Illness, immobility and inadequate nutritional support worsen skeletal-muscle loss.',.98,5.47,11.36,.30,16,NAVY,True,align=PP_ALIGN.CENTER) #10 s=base(10,'Acute phase response and insulin resistance','The liver shifts production priorities while glucose control becomes more difficult.') for x,h,co,items in [(0.85,'ACUTE-PHASE RESPONSE',TEAL,['Positive reactants ↑','CRP • plasminogen • fibrinogen','Negative reactants ↓','Albumin • transferrin • prealbumin']),(6.96,'INSULIN RESISTANCE',CORAL,['Glucose production ↑','Peripheral glucose uptake ↓','Hyperglycaemia may occur','Magnitude reflects injury severity'])]: rect(s,x,1.55,5.45,3.62,WHITE,True,line=RGBColor(219,224,220)); rect(s,x,1.55,5.45,.58,co,True); text(s,h,x+.28,1.73,4.9,.18,12,WHITE,True,align=PP_ALIGN.CENTER) for i,it in enumerate(items): text(s,'•',x+.38,2.43+i*.55,.2,.2,15,co,True); text(s,it,x+.67,2.39+i*.55,4.3,.27,14,INK) rect(s,1.38,5.85,10.55,.57,RGBColor(248,230,221),True); text(s,'Avoid unnecessary fasting and support early nutrition when appropriate.',1.72,6.03,9.9,.20,13,NAVY,True,align=PP_ALIGN.CENTER) #11 s=base(11,'Body composition: loss can be hidden by fluid gain','Protein and fat are lost while extracellular water may increase.') image(s,'IMG_2489.jpg',.92,1.39,4.15,4.15,'Chemical body composition of a normal 70-kg male') bullet(s,'What to remember',['Catabolism lowers fat mass and skeletal muscle mass.','Protein loss is accompanied by water and sodium retention.','Body weight may rise despite substantial tissue loss.'],5.95,1.72,5.75) rect(s,5.95,4.71,5.58,.76,NAVY,True); text(s,'Fluid retention can mask the severity of tissue loss.',6.25,4.97,4.98,.22,14,WHITE,True,align=PP_ALIGN.CENTER) #12 s=base(12,'Volume loss and avoidable stressors','Correcting secondary insults limits the catabolic response.') image(s,'IMG_2490.jpg',.74,1.39,7.15,3.27,'Factors that exacerbate the metabolic response to surgical injury') rect(s,8.27,1.38,3.85,3.46,WHITE,True,line=RGBColor(220,225,222)); text(s,'PRACTICAL TARGETS',8.60,1.70,3.2,.21,12,TEAL,True); text(s,'Control haemorrhage\nMaintain normothermia\nTreat sepsis\nProvide analgesia\nAvoid prolonged starvation\nEncourage mobilisation',8.60,2.15,2.95,2.05,15,INK) text(s,'Haemorrhage activates sympathetic pathways, cortisol, aldosterone and ADH - promoting salt and water retention.',.92,5.62,11.5,.31,14,NAVY,True,align=PP_ALIGN.CENTER) #13 s=base(13,'ERAS helps blunt the stress response','Multimodal perioperative care reduces adverse metabolic effects and supports earlier recovery.') image(s,'IMG_2491.jpg',.94,1.48,5.4,3.82,'Enhanced recovery after surgery (ERAS) compared with traditional care') bullet(s,'Core measures',['Minimise operative stress where possible.','Avoid prolonged fasting and excessive intravenous saline.','Use effective analgesia and maintain normothermia.','Support nutrition and early mobilisation.'],6.90,1.60,5.25) rect(s,6.90,5.05,5.02,.62,PALE,True); text(s,'Goal: preserve functional capacity and shorten recovery.',7.15,5.27,4.52,.20,12,NAVY,True,align=PP_ALIGN.CENTER) #14 s=base(14,'Take-home messages','Six ideas to carry into clinical practice and exams.') items=[('01','Injury disturbs homeostasis and triggers neuroendocrine plus immune responses.'),('02','The response is graded: greater injury causes greater and longer stress.'),('03','Ebb phase is followed by hypermetabolic, catabolic flow and later recovery.'),('04','Muscle fuel is redirected to liver, immune system and wound.'),('05','Insulin resistance, acute-phase changes and fluid retention are interconnected.'),('06','Control avoidable stressors to improve surgical recovery.')] for i,(n,t) in enumerate(items): col=i%2; row=i//2; x=.86+col*6.1; y=1.48+row*1.42 rect(s,x,y,5.52,1.02,WHITE,True,line=RGBColor(218,225,221)); rect(s,x+.18,y+.20,.58,.58,TEAL if i%2==0 else CORAL,True); text(s,n,x+.18,y+.37,.58,.18,11,WHITE,True,align=PP_ALIGN.CENTER); text(s,t,x+.95,y+.27,4.2,.5,13,INK) text(s,'Content and figures based on the supplied Bailey & Love textbook material.',.92,6.35,11.4,.23,10,MUTED,italic=True,align=PP_ALIGN.CENTER) prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/metabolic-response-revision/src/build.py" python - <<'PY' from pptx import Presentation p='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Revised.pptx'; prs=Presentation(p) print('slides',len(prs.slides),'size bytes',__import__('os').path.getsize(p)) for i,s in enumerate(prs.slides,1): print(i,len(s.shapes)) PY

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Revised.pptx') prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height issues=[] for i,slide in enumerate(prs.slides,1): for j,shape in enumerate(slide.shapes,1): if shape.left < 0 or shape.top < 0 or shape.left+shape.width > sw or shape.top+shape.height > sh: issues.append((i,j,shape.name,shape.left,shape.top,shape.width,shape.height)) print('VALIDATION: slides=',len(prs.slides),' out_of_bounds=',len(issues),' bytes=',p.stat().st_size) assert len(prs.slides)==14 assert not issues PY unzip -t "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Revised.pptx" | tail -1

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Bailey Love metabolic response to injury surgical stress response ERAS

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/Bailey_Metabolic_Response_to_Injury.pptx') prs=Presentation(str(p)) for n in [3,4,5,8,9,11,12,13,14]: s=prs.slides[n-1]; print('\nSLIDE',n) for i,sh in enumerate(s.shapes): txt=(sh.text[:60].replace('\n','|') if getattr(sh,'has_text_frame',False) else '') print(i,sh.shape_type,round(sh.left/914400,2),round(sh.top/914400,2),round(sh.width/914400,2),round(sh.height/914400,2),txt) PY

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/src/revise_simple.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches from pathlib import Path SRC='/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51/Bailey_Metabolic_Response_to_Injury.pptx' AS=Path('/tmp/workspace/attachments/07dc00cc-302c-453c-a8bf-c6147f73eb51') OUT='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Simple_Revised.pptx' prs=Presentation(SRC) def remove_shape(shape): el=shape._element el.getparent().remove(el) def remove_indices(slide, inds): for i in sorted(inds, reverse=True): remove_shape(slide.shapes[i]) def contain_add(slide, fn, x,y,w,h): from PIL import Image im=Image.open(AS/fn); iw,ih=im.size ar=iw/ih if w/h > ar: ph=h; pw=h*ar; px=x+(w-pw)/2; py=y else: pw=w; ph=w/ar; px=x; py=y+(h-ph)/2 slide.shapes.add_picture(str(AS/fn), Inches(px), Inches(py), width=Inches(pw), height=Inches(ph)) # S3: use the original printed chart instead of the drawn approximation. s=prs.slides[2] remove_indices(s, list(range(5,23))) contain_add(s,'IMG_2485.jpg',0.83,1.43,5.55,3.95) # S5: replace entirely constructed pathway with the supplied textbook figure. s=prs.slides[4] remove_indices(s, list(range(4,28))) contain_add(s,'IMG_2486.jpg',0.75,1.10,11.85,5.70) # S8: replace the synthetic transfer diagram with the supplied figure. s=prs.slides[7] remove_indices(s, list(range(4,12))) contain_add(s,'IMG_2487.jpg',0.82,1.55,11.55,2.58) # S9: replace the constructed proteolysis pathway with textbook artwork. s=prs.slides[8] remove_indices(s, list(range(8,22))) contain_add(s,'IMG_2488.jpg',5.05,1.45,7.20,4.92) # S11: replace the schematic body-composition stack. s=prs.slides[10] remove_indices(s, list(range(5,15))) contain_add(s,'IMG_2489.jpg',0.83,1.35,4.15,4.75) # S12: retain the clinical text but replace the lower constructed cascade. s=prs.slides[11] remove_indices(s, list(range(10,21))) contain_add(s,'IMG_2490.jpg',4.65,4.47,5.55,2.52) # S13: retain the ERAS points but substitute the supplied ERAS graph. s=prs.slides[12] remove_indices(s, list(range(8,23))) contain_add(s,'IMG_2491.jpg',0.85,4.15,5.35,2.83) # Remove the artificial take-home / summary slide, as requested. slide_id = prs.slides._sldIdLst[-1] rel_id = slide_id.rId prs.part.drop_rel(rel_id) prs.slides._sldIdLst.remove(slide_id) prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/metabolic-response-revision/src/revise_simple.py" python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Simple_Revised.pptx') prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height issues=[] for i,s in enumerate(prs.slides,1): for j,x in enumerate(s.shapes,1): if x.left<0 or x.top<0 or x.left+x.width>sw or x.top+x.height>sh: issues.append((i,j,x.name)) print('slides',len(prs.slides),'size',p.stat().st_size,'bounds errors',issues) for i,s in enumerate(prs.slides,1): print(i, sum(1 for x in s.shapes if x.shape_type==13), 'pictures') assert len(prs.slides)==13 and not issues PY unzip -t "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Simple_Revised.pptx" | tail -1

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metabolic response to injury surgery overview

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/src/finalize.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.dml.color import RGBColor SRC='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Simple_Revised.pptx' OUT='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx' prs=Presentation(SRC) NAVY=RGBColor(22,47,62); TEAL=RGBColor(0,112,125); WHITE=RGBColor(255,255,255) def remove_shape(sh): sh._element.getparent().remove(sh._element) def textbox(slide, txt,x,y,w,h,size,color,bold=False,align=PP_ALIGN.LEFT): b=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=b.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=tf.margin_right=Inches(.02); tf.margin_top=tf.margin_bottom=Inches(.01); tf.vertical_anchor=MSO_ANCHOR.MIDDLE p=tf.paragraphs[0]; p.text=txt; p.alignment=align; p.font.name='Aptos'; p.font.size=Pt(size); p.font.bold=bold; p.font.color.rgb=color return b # Title slide: remove every existing item, preserving a plain title slide. s=prs.slides[0] for sh in list(s.shapes): remove_shape(sh) # simple, plain background with a thin teal strip bg=s.background.fill; bg.solid(); bg.fore_color.rgb=WHITE strip=s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0), Inches(0), Inches(13.333), Inches(.16)); strip.fill.solid(); strip.fill.fore_color.rgb=TEAL; strip.line.color.rgb=TEAL textbox(s,'Metabolic Response to Injury',.78,2.75,8.8,.62,30,NAVY,True) textbox(s,'Toshiba Garg',9.70,.40,2.75,.28,13,NAVY,False,PP_ALIGN.RIGHT) # remove learning objectives and homeostasis slide (slide 2) sldId=prs.slides._sldIdLst[1]; rid=sldId.rId; prs.part.drop_rel(rid); prs.slides._sldIdLst.remove(sldId) # simple Thank You final slide s=prs.slides.add_slide(prs.slide_layouts[6]) bg=s.background.fill; bg.solid(); bg.fore_color.rgb=WHITE strip=s.shapes.add_shape(MSO_SHAPE.RECTANGLE, Inches(0), Inches(0), Inches(13.333), Inches(.16)); strip.fill.solid(); strip.fill.fore_color.rgb=TEAL; strip.line.color.rgb=TEAL textbox(s,'Thank You',0,3.18,13.333,.55,28,NAVY,True,PP_ALIGN.CENTER) textbox(s,'Toshiba Garg',0,4.02,13.333,.28,13,TEAL,False,PP_ALIGN.CENTER) prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/metabolic-response-revision/src/finalize.py" python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx') prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height print('slides',len(prs.slides),'bytes',p.stat().st_size) for i,s in enumerate(prs.slides,1): txt=' | '.join(x.text.replace('\n',' ') for x in s.shapes if getattr(x,'has_text_frame',False) and x.text.strip()) print(i,txt[:150]) for x in s.shapes: assert x.left>=0 and x.top>=0 and x.left+x.width<=sw and x.top+x.height<=sh assert len(prs.slides)==13 PY unzip -t "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx" | tail -1

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/src/finalize_clean.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.dml.color import RGBColor SRC='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Simple_Revised.pptx' OUT='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx' prs=Presentation(SRC) NAVY=RGBColor(22,47,62); TEAL=RGBColor(0,112,125); WHITE=RGBColor(255,255,255) def remove(sh): sh._element.getparent().remove(sh._element) def textbox(s,txt,x,y,w,h,sz,col,bold=False,align=PP_ALIGN.LEFT): b=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); t=b.text_frame; t.clear(); t.margin_left=t.margin_right=Inches(.02); t.margin_top=t.margin_bottom=Inches(.01); t.vertical_anchor=MSO_ANCHOR.MIDDLE p=t.paragraphs[0]; p.text=txt; p.alignment=align; p.font.name='Aptos'; p.font.size=Pt(sz); p.font.bold=bold; p.font.color.rgb=col # First slide s=prs.slides[0] for sh in list(s.shapes): remove(sh) s.background.fill.solid(); s.background.fill.fore_color.rgb=WHITE bar=s.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(0),Inches(0),Inches(13.333),Inches(.16)); bar.fill.solid(); bar.fill.fore_color.rgb=TEAL; bar.line.color.rgb=TEAL textbox(s,'Metabolic Response to Injury',.78,2.76,9,.58,30,NAVY,True) textbox(s,'Toshiba Garg',9.7,.40,2.75,.28,13,NAVY,False,PP_ALIGN.RIGHT) # Delete learning-objectives slide sid=prs.slides._sldIdLst[1]; prs.part.drop_rel(sid.rId); prs.slides._sldIdLst.remove(sid) # Change now-final ERAS slide into Thank You, rather than adding a new slide s=prs.slides[-1] for sh in list(s.shapes): remove(sh) s.background.fill.solid(); s.background.fill.fore_color.rgb=WHITE bar=s.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(0),Inches(0),Inches(13.333),Inches(.16)); bar.fill.solid(); bar.fill.fore_color.rgb=TEAL; bar.line.color.rgb=TEAL textbox(s,'Thank You',0,3.18,13.333,.55,28,NAVY,True,PP_ALIGN.CENTER) textbox(s,'Toshiba Garg',0,4.02,13.333,.28,13,TEAL,False,PP_ALIGN.CENTER) prs.save(OUT) print(OUT) ''') PY rm -f "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx" && python "/tmp/workspace/metabolic-response-revision/src/finalize_clean.py" python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx') prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height assert len(prs.slides)==12, len(prs.slides) for i,s in enumerate(prs.slides,1): t=' | '.join(x.text.replace('\n',' ') for x in s.shapes if getattr(x,'has_text_frame',False) and x.text.strip()) print(i,t[:110]) for x in s.shapes: assert x.left>=0 and x.top>=0 and x.left+x.width<=sw and x.top+x.height<=sh assert 'Learning objectives' not in '\n'.join(x.text for s in prs.slides for x in s.shapes if getattr(x,'has_text_frame',False)) assert 'Bailey & Love' not in '\n'.join(x.text for x in prs.slides[0].shapes if getattr(x,'has_text_frame',False)) print('Validated',p.stat().st_size) PY unzip -t "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx" | tail -1

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/src/finalize_correct.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.enum.shapes import MSO_SHAPE from pptx.dml.color import RGBColor SRC='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Simple_Revised.pptx' OUT='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx' prs=Presentation(SRC) NAVY=RGBColor(22,47,62); TEAL=RGBColor(0,112,125); WHITE=RGBColor(255,255,255) def remove(sh): sh._element.getparent().remove(sh._element) def tb(s,txt,x,y,w,h,sz,col,bold=False,align=PP_ALIGN.LEFT): b=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); t=b.text_frame; t.clear(); t.margin_left=t.margin_right=Inches(.02); t.margin_top=t.margin_bottom=Inches(.01); t.vertical_anchor=MSO_ANCHOR.MIDDLE p=t.paragraphs[0]; p.text=txt; p.alignment=align; p.font.name='Aptos'; p.font.size=Pt(sz); p.font.bold=bold; p.font.color.rgb=col # revise cover s=prs.slides[0] for sh in list(s.shapes): remove(sh) s.background.fill.solid(); s.background.fill.fore_color.rgb=WHITE bar=s.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(0),Inches(0),Inches(13.333),Inches(.16)); bar.fill.solid(); bar.fill.fore_color.rgb=TEAL; bar.line.color.rgb=TEAL tb(s,'Metabolic Response to Injury',.78,2.76,9,.58,30,NAVY,True) tb(s,'Toshiba Garg',9.7,.40,2.75,.28,13,NAVY,False,PP_ALIGN.RIGHT) # Add Thank You while deck still has all original relationships, then remove learning objectives. s=prs.slides.add_slide(prs.slide_layouts[6]) s.background.fill.solid(); s.background.fill.fore_color.rgb=WHITE bar=s.shapes.add_shape(MSO_SHAPE.RECTANGLE,Inches(0),Inches(0),Inches(13.333),Inches(.16)); bar.fill.solid(); bar.fill.fore_color.rgb=TEAL; bar.line.color.rgb=TEAL tb(s,'Thank You',0,3.18,13.333,.55,28,NAVY,True,PP_ALIGN.CENTER) tb(s,'Toshiba Garg',0,4.02,13.333,.28,13,TEAL,False,PP_ALIGN.CENTER) # Remove slide 2 learning objectives. sid=prs.slides._sldIdLst[1]; prs.part.drop_rel(sid.rId); prs.slides._sldIdLst.remove(sid) prs.save(OUT) ''') PY rm -f "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx" && python "/tmp/workspace/metabolic-response-revision/src/finalize_correct.py" python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx'); prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height print('slides:',len(prs.slides),'bytes:',p.stat().st_size) for i,s in enumerate(prs.slides,1): text=' | '.join(x.text.replace('\n',' ') for x in s.shapes if getattr(x,'has_text_frame',False) and x.text.strip()) print(i,text[:125]) for x in s.shapes: assert x.left>=0 and x.top>=0 and x.left+x.width<=sw and x.top+x.height<=sh alltext='\n'.join(x.text for s in prs.slides for x in s.shapes if getattr(x,'has_text_frame',False)) assert len(prs.slides)==13 assert 'Learning objectives' not in alltext assert 'Bailey & Love' not in '\n'.join(x.text for x in prs.slides[0].shapes if getattr(x,'has_text_frame',False)) assert 'Concepts behind enhanced recovery after surgery' in alltext assert prs.slides[-1].shapes[1].text == 'Thank You' PY unzip -t "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx" | tail -1

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metabolic response to injury surgery overview

python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/src/update_cover_purple.py') p.write_text(r'''from pptx import Presentation from pptx.util import Inches from pptx.dml.color import RGBColor from pptx.enum.text import PP_ALIGN SRC='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg.pptx' OUT='/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg_Final.pptx' PURPLE=RGBColor(101,72,143) prs=Presentation(SRC) def remove_shape(sh): sh._element.getparent().remove(sh._element) def add_name(slide): b=slide.shapes.add_textbox(Inches(9.65), Inches(6.72), Inches(2.8), Inches(.28)) tf=b.text_frame; tf.clear(); tf.margin_left=tf.margin_right=Inches(.02); tf.margin_top=tf.margin_bottom=Inches(.01) p=tf.paragraphs[0]; p.text='Toshiba Garg'; p.alignment=PP_ALIGN.RIGHT p.font.name='Aptos'; p.font.size=__import__('pptx').util.Pt(13); p.font.color.rgb=PURPLE # First slide: move name from top right to bottom right; recolour the existing top strip purple. s=prs.slides[0] for sh in list(s.shapes): if getattr(sh,'has_text_frame',False) and sh.text.strip()=='Toshiba Garg': remove_shape(sh) for sh in s.shapes: if sh.shape_type==1 and sh.top < Inches(.25): sh.fill.solid(); sh.fill.fore_color.rgb=PURPLE; sh.line.color.rgb=PURPLE add_name(s) # Final thank-you slide: remove name and recolour its strip purple. s=prs.slides[-1] for sh in list(s.shapes): if getattr(sh,'has_text_frame',False) and sh.text.strip()=='Toshiba Garg': remove_shape(sh) for sh in s.shapes: if sh.shape_type==1 and sh.top < Inches(.25): sh.fill.solid(); sh.fill.fore_color.rgb=PURPLE; sh.line.color.rgb=PURPLE prs.save(OUT) print(OUT) ''') PY python "/tmp/workspace/metabolic-response-revision/src/update_cover_purple.py" python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg_Final.pptx') prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height print('slides',len(prs.slides),'bytes',p.stat().st_size) for si in [0,-1]: s=prs.slides[si]; print('slide',si+1 if si>=0 else len(prs.slides),[(x.text,round(x.left/914400,2),round(x.top/914400,2)) for x in s.shapes if getattr(x,'has_text_frame',False) and x.text.strip()]) for x in s.shapes: assert x.left>=0 and x.top>=0 and x.left+x.width<=sw and x.top+x.height<=sh assert any(x.text=='Toshiba Garg' and x.top>Inches(6) for x in prs.slides[0].shapes if getattr(x,'has_text_frame',False)) assert not any(x.text=='Toshiba Garg' for x in prs.slides[-1].shapes if getattr(x,'has_text_frame',False)) PY unzip -t "/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg_Final.pptx" | tail -1

python - <<'PY' from pptx import Presentation from pptx.util import Inches from pathlib import Path p=Path('/tmp/workspace/metabolic-response-revision/output/Metabolic_Response_to_Injury_Toshiba_Garg_Final.pptx') prs=Presentation(str(p)); sw,sh=prs.slide_width,prs.slide_height assert len(prs.slides)==13 cover=prs.slides[0]; thank=prs.slides[-1] assert any(x.text=='Toshiba Garg' and x.top>Inches(6) for x in cover.shapes if getattr(x,'has_text_frame',False)) assert not any(x.text=='Toshiba Garg' for x in thank.shapes if getattr(x,'has_text_frame',False)) for s in prs.slides: for x in s.shapes: assert x.left>=0 and x.top>=0 and x.left+x.width<=sw and x.top+x.height<=sh print('Verified: 13 slides, name bottom-right on cover only, purple accents applied.') PY