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surgical injury metabolic response

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mkdir -p "/tmp/workspace/bailey-metabolic-response-ppt/src" "/tmp/workspace/bailey-metabolic-response-ppt/output" "/tmp/workspace/bailey-metabolic-response-ppt/assets" && python - <<'PY' from PIL import Image from pathlib import Path src=Path('/tmp/workspace/attachments/9b268547-7cfe-485c-a707-d5a3555015a7') out=Path('/tmp/workspace/bailey-metabolic-response-ppt/assets') for p in sorted(src.glob('*.jpg')): im=Image.open(p) # Pages are rotated counterclockwise visually, rotate CW 90 rot=im.rotate(-90, expand=True) rot.save(out/(p.stem+'_upright.jpg'), quality=90) print('processed', len(list(src.glob('*.jpg')))) PY

python - <<'PY' from PIL import Image from pathlib import Path for p in sorted(Path('/tmp/workspace/bailey-metabolic-response-ppt/assets').glob('*.jpg')): im=Image.open(p) print(p.name, im.size) PY

cat > "/tmp/workspace/bailey-metabolic-response-ppt/src/create_ppt.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor from pptx.enum.dml import MSO_THEME_COLOR from pptx.enum.chart import XL_CHART_TYPE, XL_LEGEND_POSITION from pptx.chart.data import CategoryChartData from pptx.enum.text import MSO_AUTO_SIZE OUT='/tmp/workspace/bailey-metabolic-response-ppt/output/Metabolic_response_to_injury_Bailey.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5) blank=prs.slide_layouts[6] # Palette drawn from supplied chapter pages PURPLE=RGBColor(83,55,114); LAV=RGBColor(231,225,238); DEEP=RGBColor(49,43,63) TEAL=RGBColor(43,119,122); MINT=RGBColor(216,236,230); GOLD=RGBColor(204,164,87) RED=RGBColor(172,76,81); BLUE=RGBColor(76,132,173); GREEN=RGBColor(106,144,92) GREY=RGBColor(92,92,100); LIGHT=RGBColor(248,247,249); WHITE=RGBColor(255,255,255) def fill(shape,c): shape.fill.solid(); shape.fill.fore_color.rgb=c def line(shape,c,width=1): shape.line.color.rgb=c; shape.line.width=Pt(width) def box(slide,x,y,w,h,color=WHITE, radius=False, linec=None): s=slide.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if radius else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y), Inches(w),Inches(h)); fill(s,color); line(s,linec or color,0.7); return s def text(slide,txt,x,y,w,h,size=18,color=DEEP,bold=False,align=PP_ALIGN.LEFT, font='Aptos', valign=MSO_ANCHOR.TOP): t=slide.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h)); tf=t.text_frame; tf.clear(); tf.word_wrap=True; tf.margin_left=Inches(.04);tf.margin_right=Inches(.04);tf.margin_top=Inches(.02);tf.margin_bottom=Inches(.02);tf.vertical_anchor=valign for i,part in enumerate(txt.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph(); p.text=part; p.font.name=font;p.font.size=Pt(size);p.font.bold=bold;p.font.color.rgb=color;p.alignment=align;p.space_after=Pt(2) return t def bullet(slide, items,x,y,w,h,size=18,color=DEEP): t=slide.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h)); tf=t.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=Inches(.04);tf.margin_right=Inches(.04);tf.margin_top=Inches(.02) for i,item in enumerate(items): p=tf.paragraphs[0] if i==0 else tf.add_paragraph();p.text=item;p.font.name='Aptos';p.font.size=Pt(size);p.font.color.rgb=color;p.level=0;p.text='• '+p.text;p.space_after=Pt(8) return t def arrow(slide,x1,y1,x2,y2,color=PURPLE,width=2,head=True): c=slide.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2));c.line.color.rgb=color;c.line.width=Pt(width) if head: c.line.end_arrowhead=True return c def header(slide,title,subtitle=None,n=None): box(slide,0,0,13.333,.55,PURPLE) text(slide,title,.48,.09,10.7,.33,26,WHITE,True) if subtitle: text(slide,subtitle,.5,.62,12.2,.27,11,GREY) if n: text(slide,str(n),12.55,.11,.35,.25,13,WHITE,True,PP_ALIGN.RIGHT) box(slide,.48,7.15,12.35,.02,LAV) def title_slide(title,sub): s=prs.slides.add_slide(blank);fill(s.background,PURPLE) # layered accents box(s,0,0,13.333,7.5,PURPLE) box(s,0,5.78,13.333,1.72,RGBColor(68,43,94)) box(s,.65,.8,.12,4.25,GOLD) text(s,'BAILEY & LOVE',1.0,.9,4,.32,15,LAV,True) text(s,title,1.0,1.55,10.5,1.6,34,WHITE,True) text(s,sub,1.03,3.35,9.5,.55,20,LAV) text(s,'Prepared only from the supplied Bailey & Love textbook pages',1.03,6.48,8,.25,13,WHITE) return s def section(s,heading,x,y,w): text(s,heading,x,y,w,.4,19,PURPLE,True) box(s,x,y+.43,w,.035,GOLD) def labelbox(s,label,x,y,w,h,fc=MINT,tc=DEEP,fs=15): sh=box(s,x,y,w,h,fc,True,RGBColor(198,190,206));text(s,label,x+.08,y+.06,w-.16,h-.12,fs,tc,True,PP_ALIGN.CENTER,valign=MSO_ANCHOR.MIDDLE);return sh # 1 s=title_slide('Metabolic response to injury','Basic principles: homeostasis, stress response and recovery') # 2 s=prs.slides.add_slide(blank);header(s,'Learning objectives and homeostasis','Chapter overview',2) section(s,'Learning objectives',.65,1.05,5.6) bullet(s,['Classical concepts of homeostasis','Metabolic changes in response to injury','Physiological and biochemical changes during injury and recovery'],.75,1.68,5.5,2.0,19) section(s,'Homeostasis',6.85,1.05,5.7) bullet(s,['Maintains a stable internal environment','Co-ordinated physiological processes maintain the organism','Stressors disturb equilibrium; compensatory responses aim to restore it'],6.95,1.68,5.4,2.0,18) box(s,.7,4.45,11.95,1.55,LAV,True) text(s,'Surgical practice seeks to reduce the metabolic stress response while returning the patient to a stable state in which healing and recovery can proceed.',1.0,4.75,11.4,.75,22,DEEP,False,PP_ALIGN.CENTER,valign=MSO_ANCHOR.MIDDLE) #3 s=prs.slides.add_slide(blank);header(s,'The graded nature of the injury response','Response varies with severity and time',3) section(s,'Magnitude and duration of metabolic response',.65,1.0,6.3) # plot area box(s,.9,1.7,5.4,3.8,WHITE,False,GREY);arrow(s,1.25,5.08,5.9,5.08,GREY,1,False);arrow(s,1.25,5.08,1.25,2.0,GREY,1,False) text(s,'Days',3.1,5.18,1,.25,13,GREY,False,PP_ALIGN.CENTER);text(s,'Relative metabolic rate',.45,2.65,.6,1.5,13,GREY,False,PP_ALIGN.CENTER) # curves polyline fake using connectors pts=[(1.3,5.0),(1.5,3.8),(1.8,2.55),(2.15,2.15),(2.5,2.45),(2.8,3.1),(3.2,3.85),(3.8,4.5),(4.7,4.95)] for a,b in zip(pts,pts[1:]): arrow(s,*a,*b,RED,2,False) pts2=[(1.3,5.0),(1.55,4.3),(1.9,3.65),(2.3,3.4),(2.75,3.7),(3.25,4.25),(4.0,4.8)] for a,b in zip(pts2,pts2[1:]): arrow(s,*a,*b,BLUE,2,False) pts3=[(1.3,5.0),(1.55,4.7),(1.9,4.5),(2.3,4.55),(2.8,4.7),(3.4,4.95)] for a,b in zip(pts3,pts3[1:]): arrow(s,*a,*b,GREEN,2,False) text(s,'Major trauma',3.7,2.35,1.4,.25,14,RED,True);text(s,'Minor trauma',3.55,3.75,1.4,.25,14,BLUE,True);text(s,'Normal range',4.25,4.5,1.3,.25,13,GREEN,True) section(s,'Key principle',7.2,1.0,5.25) bullet(s,['More severe injury produces a greater response.','The response evolves with time.','Following major trauma, systemic inflammatory response syndrome, hypermetabolism, marked catabolism and organ dysfunction may occur.'],7.3,1.7,5,2.6,18) labelbox(s,'Injury severity and the host response determine the metabolic pattern.',7.4,4.75,4.8,.7,LAV,PURPLE,17) #4 s=prs.slides.add_slide(blank);header(s,'Mediators of the metabolic response to injury','Neuroendocrine stress response',4) section(s,'Classical neuroendocrine pathways',.65,1.0,5.9) bullet(s,['Afferent nociceptive pathways transmit signals to the hypothalamus and pituitary.','Anterior pituitary: ACTH release → adrenal cortisol release.','Sympathetic activation → catecholamine release.','Additional changes include glucagon ↑, insulin ↓, growth hormone ↑ and prolactin ↑.'],.75,1.65,5.7,3.2,17) section(s,'Plasma changes and body metabolism',7.05,1.0,5.55) # table rows=[('ACTH / GH','↑'),('Adrenaline / cortisol','↑'),('Glucagon','↑'),('IL-1, TNF-α, IL-6, IL-8','↑'),('Insulin / testosterone','↓')] y=1.6 for i,(a,b) in enumerate(rows): box(s,7.15,y,3.8,.52,WHITE if i%2==0 else LAV,False,LAV);text(s,a,7.3,y+.12,3.15,.22,15,DEEP);box(s,11.05,y,.8,.52,MINT if b=='↑' else RGBColor(247,224,224),False,LAV);text(s,b,11.2,y+.08,.45,.26,20,TEAL if b=='↑' else RED,True,PP_ALIGN.CENTER);y+=.53 labelbox(s,'Result: increased lipolysis, hepatic gluconeogenesis, acute-phase protein synthesis, proteolysis and hypermetabolism.',7.2,4.75,4.75,.86,LAV,PURPLE,16) #5 integrated response s=prs.slides.add_slide(blank);header(s,'Integrated neuroendocrine and immune response','Reconstruction of the response pathway',5) labelbox(s,'Injury',.65,3.2,1.2,.65,RGBColor(251,232,205),DEEP,18) arrow(s,1.85,3.52,3.1,3.52,RED,2.5) labelbox(s,'Spinal cord\nafferent pathways',3.15,2.8,1.7,1.35,LAV,PURPLE,15) arrow(s,4.85,3.5,5.75,2.05,PURPLE,2.2);arrow(s,4.85,3.5,5.75,4.9,PURPLE,2.2) labelbox(s,'Hypothalamus\nCRF',5.8,1.55,1.55,.85,MINT,DEEP,16);labelbox(s,'Adaptive immune\nsystem',5.8,4.45,1.55,.85,MINT,DEEP,15) arrow(s,7.35,1.95,8.35,1.95,RED,2);arrow(s,7.35,4.88,8.35,4.88,RED,2) labelbox(s,'Pituitary\nACTH ↑ GH ↑',8.4,1.55,1.55,.85,WHITE,DEEP,15);labelbox(s,'Innate immune system\nIL-1 / IL-6 / TNF-α ↑',8.4,4.35,1.75,1.05,WHITE,DEEP,14) arrow(s,9.95,1.95,10.85,1.95,RED,2);arrow(s,10.15,4.9,10.85,4.25,RED,2) labelbox(s,'Adrenal\ncortisol ↑\nadrenaline ↑',10.9,1.38,1.5,1.18,RGBColor(252,239,239),DEEP,14);labelbox(s,'Glucagon ↑\nInsulin ↓',10.9,3.9,1.5,.7,RGBColor(252,239,239),DEEP,15) text(s,'Metabolic effects',.8,6.2,2.5,.3,19,PURPLE,True) text(s,'Adipocyte lipolysis ↑ Hepatic gluconeogenesis ↑ Skeletal-muscle protein degradation ↑ Hepatic acute-phase protein synthesis ↑ Pyrexia Hypermetabolism',.8,6.62,11.8,.3,15,DEEP,False,PP_ALIGN.CENTER) #6 inflammatory s=prs.slides.add_slide(blank);header(s,'Systemic inflammatory response following major injury','Interaction of pro- and anti-inflammatory forces',6) section(s,'Initial proinflammatory response',.7,1.0,5.8) bullet(s,['Driven initially by proinflammatory cytokines: IL-1, IL-6 and TNF-α.','Within hours, cytokines and acute-phase mediators amplify the response.','The response may become self-perpetuating.'],.8,1.65,5.35,2.0,18) section(s,'Counter-regulation',7.0,1.0,5.45) bullet(s,['Increased plasma levels of cytokine receptor antagonists and soluble receptors follow.','A balance of pro- and anti-inflammatory activity is required.','Excessive response may evolve into a counterinflammatory response syndrome.'],7.1,1.65,5.1,2.0,18) box(s,.85,4.45,11.65,.98,LAV,True);text(s,'Cytokines, cortisol, catecholamines and immune pathways form a complex interacting system. Persistent imbalance contributes to complications and impaired recovery.',1.15,4.72,11.0,.48,20,PURPLE,False,PP_ALIGN.CENTER) #7 s=prs.slides.add_slide(blank);header(s,'Metabolic stress response: the ebb and flow model','Phases of the physiological response to injury',7) # timeline arrow(s,.95,2.15,12.35,2.15,PURPLE,2.5) for x,title,tm,desc,clr in [(1.0,'Ebb phase','Hours','Shock',BLUE),(4.25,'Flow phase','Days','Catabolism',RED),(8.45,'Recovery','Weeks','Anabolism',GREEN)]: box(s,x,1.3,2.45,.65,clr,True);text(s,title,x+.1,1.47,2.25,.22,19,WHITE,True,PP_ALIGN.CENTER);text(s,tm,x+.2,2.42,2.05,.25,17,GREY,False,PP_ALIGN.CENTER);text(s,desc,x+.2,2.76,2.05,.28,20,PURPLE,True,PP_ALIGN.CENTER) section(s,'Ebb phase',.9,3.55,3.0);bullet(s,['Begins at injury','Lasts about 24-48 hours','Hypovolaemia, reduced metabolic rate, reduced cardiac output, hypothermia and lactic acidosis'],.95,4.1,3,1.75,16) section(s,'Flow phase',4.45,3.55,3.65);bullet(s,['Catabolic phase: days','Hypermetabolism, increased cardiac output, pyrexia, leucocytosis and increased oxygen consumption','Followed by an anabolic phase lasting weeks'],4.5,4.1,3.45,1.9,16) section(s,'Recovery',8.75,3.55,3.1);bullet(s,['Body stores are restored','Anabolism and repair predominate','May require several weeks'],8.8,4.1,2.9,1.55,16) #8 s=prs.slides.add_slide(blank);header(s,'Key catabolic elements of the flow phase','Central tissues are prioritised',8) labelbox(s,'Peripheral tissues\nMuscle • adipose tissue • skin',.7,2.05,3.1,1.2,MINT,DEEP,17) arrow(s,3.95,2.65,5.45,2.65,GOLD,2.5) labelbox(s,'Amino acids\nespecially Gln and Ala',5.55,2.1,2.2,1.1,RGBColor(247,238,205),DEEP,17) arrow(s,7.8,2.65,9.25,2.65,GOLD,2.5) labelbox(s,'Central tissues\nLiver • immune system • wound',9.35,2.05,3.15,1.2,RGBColor(250,230,230),DEEP,17) text(s,'Protein metabolism shifts away from peripheral tissues towards visceral, immune and wound requirements.',1.0,4.1,11.3,.5,22,PURPLE,False,PP_ALIGN.CENTER) section(s,'Hypermetabolism',.95,5.0,3.2);section(s,'Skeletal muscle protein metabolism',4.9,5.0,3.7);section(s,'Acute-phase response',9.25,5.0,3.0) bullet(s,['Increased energy expenditure','Increased oxygen consumption'],1.0,5.48,3.1,1.0,15) bullet(s,['Net protein catabolism','Amino-acid release from muscle'],4.95,5.48,3.65,1.0,15) bullet(s,['Hepatic protein synthesis shifts','Positive reactants rise'],9.3,5.48,2.9,1.0,15) #9 s=prs.slides.add_slide(blank);header(s,'Alterations in skeletal-muscle protein metabolism','Muscle wasting during the acute phase',9) section(s,'Protein turnover',.7,1.0,4.1) bullet(s,['Muscle protein is continuously synthesised and broken down.','Normal circumstances: synthesis equals breakdown.','During injury, net muscle protein accretion falls, especially when extracellular amino-acid concentration falls.'],.8,1.6,4.2,2.65,17) section(s,'Clinical consequences',.7,4.75,4.1) bullet(s,['Marked skeletal-muscle wasting can impair function and quality of life.','Illness, immobilisation and inadequate nutritional support worsen loss.'],.8,5.28,4.2,1.15,17) # pathway labelbox(s,'Myofibrillar\nprotein',6.2,1.55,1.8,.8,MINT,DEEP,16);arrow(s,7.1,2.38,8.25,3.0,RED,2.5) labelbox(s,'Caspases, cathepsins\nand calpains',8.15,2.75,2.05,.85,RGBColor(251,232,205),DEEP,14);arrow(s,10.2,3.2,10.55,4.25,RED,2.5) labelbox(s,'Ubiquitinated\nprotein',10.4,4.2,1.75,.8,LAV,PURPLE,15);arrow(s,11.25,5.0,9.8,5.65,RED,2.5) labelbox(s,'26S proteasome\nATP',8.0,5.35,1.8,.85,RGBColor(247,238,205),DEEP,15);arrow(s,8.0,5.78,6.55,5.78,RED,2.5) labelbox(s,'Oligopeptides →\nAmino acids',5.15,5.35,1.75,.85,MINT,DEEP,15) text(s,'ATP-dependent ubiquitin-proteasome pathway: a dominant mechanism of muscle protein degradation.',5.4,6.55,6.6,.38,16,PURPLE,False,PP_ALIGN.CENTER) #10 s=prs.slides.add_slide(blank);header(s,'Hepatic acute-phase response and insulin resistance','Metabolic priorities are redirected',10) section(s,'Acute-phase response',.7,1.0,5.8) bullet(s,['Hepatic acute-phase response represents a reprioritisation of body metabolism towards the liver and the injured tissues.','Positive reactants rise: C-reactive protein, plasminogen and fibrinogen.','Negative reactants fall: albumin, transferrin and prealbumin.'],.8,1.6,5.5,2.5,17) section(s,'Insulin resistance',7.0,1.0,5.45) bullet(s,['Following surgery or trauma, hyperglycaemia may occur due to increased glucose production and reduced glucose uptake.','Insulin resistance is proportional to the magnitude and duration of injury.','Early nutritional support and avoidance of unnecessary fasting are important.'],7.1,1.6,5.1,2.5,17) # simple positive/negative table box(s,1.0,4.95,5.1,1.1,RGBColor(241,249,243),True);text(s,'Positive acute-phase reactants\nCRP • plasminogen • fibrinogen',1.25,5.18,4.6,.5,17,GREEN,True,PP_ALIGN.CENTER) box(s,7.15,4.95,5.1,1.1,RGBColor(252,239,239),True);text(s,'Negative acute-phase reactants\nAlbumin • transferrin • prealbumin',7.4,5.18,4.6,.5,17,RED,True,PP_ALIGN.CENTER) #11 s=prs.slides.add_slide(blank);header(s,'Changes in body composition following injury','Lean body mass, water and protein changes',11) section(s,'Normal 70-kg male body composition',.7,1.0,5.3) # stack bar x=1.15;y=1.6;w=2.15 segments=[('Fat',.85,RGBColor(241,225,153)),('Protein',.72,RGBColor(231,202,158)),('Intracellular\nwater',1.75,RGBColor(191,215,233)),('Extracellular\nwater',.85,LAV),('Minerals',.37,RGBColor(184,210,165))] cur=y for name,h,c in segments: box(s,x,cur,w,h,c,False,DEEP);text(s,name,x+.08,cur+(h-.3)/2,w-.16,.35,15,DEEP,False,PP_ALIGN.CENTER,valign=MSO_ANCHOR.MIDDLE);cur+=h text(s,'FFM or LBM',3.55,3.2,1.7,.3,16,DEEP,True) # brace imitation arrow(s,3.45,2.9,3.45,5.8,DEEP,1.5,False) section(s,'Effect of critical illness',6.2,1.0,5.7) bullet(s,['Catabolism leads to a decrease in fat mass and skeletal muscle mass.','Body weight may paradoxically increase because of expansion of extracellular fluid space.','Protein losses are accompanied by water and sodium retention.'],6.3,1.6,5.35,2.2,18) labelbox(s,'Loss of body protein with fluid retention can mask the true degree of tissue loss.',6.4,4.75,5.0,.82,LAV,PURPLE,17) #12 s=prs.slides.add_slide(blank);header(s,'Volume loss and avoidable factors','Factors that compound the response to injury',12) section(s,'Volume loss',.7,1.0,3.8) bullet(s,['Haemorrhage stimulates sympathetic activity, catecholamines, ACTH, cortisol, aldosterone and ADH.','Aldosterone increases renal sodium reabsorption; ADH conserves water.','Salt and water retention may cause peripheral and visceral oedema.'],.8,1.55,3.85,2.8,16) section(s,'Avoidable factors',5.0,1.0,3.2) bullet(s,['Continuing haemorrhage','Hypothermia','Sepsis','Tissue underperfusion','Starvation','Immobility'],5.1,1.55,2.6,2.75,17) section(s,'Compounding factors',8.7,1.0,3.9) bullet(s,['Hypothermia','Starvation','Tissue oedema','Systemic inflammation and underperfusion','Immobility'],8.8,1.55,3.65,2.8,16) # feedback flow labelbox(s,'Wound\nhypothermia\nsepsis\npain',1.0,5.15,1.85,1.05,RGBColor(251,232,205),DEEP,15);arrow(s,2.9,5.65,4.25,5.65,RED,2.3);labelbox(s,'Adreno-sympathetic\nactivation',4.3,5.25,2.0,.8,LAV,PURPLE,15);arrow(s,6.35,5.65,7.5,5.65,RED,2.3);labelbox(s,'Acute-phase response\nInsulin resistance\nProtein degradation',7.55,5.08,2.35,1.15,LAV,PURPLE,14);arrow(s,9.95,5.65,11.15,5.65,RED,2.3);labelbox(s,'Catabolism +',11.2,5.28,1.3,.7,RGBColor(252,239,239),RED,16) #13 s=prs.slides.add_slide(blank);header(s,'Concepts behind enhanced recovery after surgery','Attenuate the stress response and support recovery',13) section(s,'Aim',.7,1.0,5.6) bullet(s,['Traditional perioperative care may reinforce the stress response.','The aim is to reduce unnecessary adverse metabolic effects and promote recovery.','The effect of surgery is influenced by operative magnitude, pain, fasting, fluids, immobility and nutritional status.'],.8,1.6,5.55,2.35,18) section(s,'Proactive measures from the supplied pages',7.0,1.0,5.4) bullet(s,['Minimise surgical stress where possible','Avoid prolonged fasting and excessive intravenous saline','Use effective analgesia, including epidural analgesia where appropriate','Maintain normothermia','Avoid periods of starvation','Encourage early mobilisation'],7.1,1.55,5.0,3.0,16) # graph arrow(s,1.2,6.4,5.9,6.4,GREY,1,False);arrow(s,1.2,6.4,1.2,4.55,GREY,1,False) text(s,'Days',3.15,6.55,.7,.2,12,GREY);text(s,'Functional capacity',.35,5.18,.7,.5,12,GREY) # traditional u curve pts=[(1.3,5.0),(1.8,5.6),(2.6,6.1),(3.5,6.12),(4.25,5.65),(4.85,5.05),(5.5,4.9)] for a,b in zip(pts,pts[1:]):arrow(s,*a,*b,BLUE,2,False) pts=[(1.3,5.0),(1.75,5.35),(2.4,5.65),(3.15,5.62),(3.8,5.28),(4.3,4.82),(5.3,4.75)] for a,b in zip(pts,pts[1:]):arrow(s,*a,*b,GREEN,2,False) text(s,'Traditional care',2.2,6.15,1.35,.2,12,BLUE,True);text(s,'Multimodal ERAS intervention',3.65,4.58,1.8,.3,12,GREEN,True) #14 s=prs.slides.add_slide(blank);header(s,'Summary','Metabolic response to injury',14) items=[('1','Homeostasis is disturbed by injury; compensatory neuroendocrine and immune responses follow.'),('2','Magnitude and duration of response increase with injury severity.'),('3','The ebb phase is followed by a hypermetabolic, catabolic flow phase and later recovery.'),('4','Muscle protein is mobilised to support central tissues, the immune system and the wound.'),('5','Catabolism, insulin resistance, fluid retention and acute-phase changes form an interconnected response.'),('6','Reducing avoidable stressors supports recovery after surgery.')] y=1.05 for n,txt in items: box(s,.85,y,.58,.58,PURPLE,True);text(s,n,.85,y+.1,.58,.3,18,WHITE,True,PP_ALIGN.CENTER);text(s,txt,1.65,y+.08,10.7,.45,18,DEEP);y+=.86 text(s,'All content in this presentation has been drawn only from the supplied Bailey & Love pages.',.85,6.55,11.7,.28,13,GREY,False,PP_ALIGN.CENTER) # slide footer references only page-source no citations for i,sl in enumerate(prs.slides,1): # add subtle source note except title if i>1: text(sl,'Source: supplied Bailey & Love textbook pages',.5,7.23,4,.14,8,RGBColor(130,125,138)) prs.save(OUT) print(OUT, len(prs.slides)) PY python "/tmp/workspace/bailey-metabolic-response-ppt/src/create_ppt.py"

python - <<'PY' from pptx import Presentation from pathlib import Path p=Path('/tmp/workspace/bailey-metabolic-response-ppt/output/Metabolic_response_to_injury_Bailey.pptx') prs=Presentation(str(p)) # Remove source footer shapes which were expressly not wanted for slide in prs.slides: for shape in list(slide.shapes): if getattr(shape, 'has_text_frame', False) and shape.text_frame.text.strip() == 'Source: supplied Bailey & Love textbook pages': sp=shape._element sp.getparent().remove(sp) prs.save(str(p)) # Verify reopen and catalogue slides check=Presentation(str(p)) assert len(check.slides)==14 for i, slide in enumerate(check.slides,1): strings=[] for shape in slide.shapes: if getattr(shape,'has_text_frame',False): tx=shape.text_frame.text.strip() if tx: strings.append(tx.replace('\n',' | ')) print(i, strings[:2]) print('Verified:',p, 'bytes=',p.stat().st_size) PY

~/bailey-metabolic-response-ppt/output

~/

mkdir -p "/tmp/workspace/bailey-ppt/output" "/tmp/workspace/bailey-ppt/src" && cat > "/tmp/workspace/bailey-ppt/src/make.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE, MSO_CONNECTOR from pptx.enum.text import PP_ALIGN, MSO_ANCHOR from pptx.dml.color import RGBColor P='/tmp/workspace/bailey-ppt/output/Bailey_Metabolic_Response_to_Injury.pptx' prs=Presentation(); prs.slide_width=Inches(13.333); prs.slide_height=Inches(7.5); blank=prs.slide_layouts[6] PUR=RGBColor(83,55,114); LAV=RGBColor(234,228,240); DK=RGBColor(44,39,53); WH=RGBColor(255,255,255); TEAL=RGBColor(42,119,122); GOLD=RGBColor(204,164,87); RED=RGBColor(170,74,79); BLUE=RGBColor(78,132,172); GREEN=RGBColor(93,143,92); GREY=RGBColor(94,94,100) def rect(s,x,y,w,h,c,round=False,lc=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if round else MSO_SHAPE.RECTANGLE, Inches(x),Inches(y),Inches(w),Inches(h));sh.fill.solid();sh.fill.fore_color.rgb=c;sh.line.color.rgb=lc or c;return sh def tx(s,t,x,y,w,h,sz=18,c=DK,b=False,a=PP_ALIGN.LEFT): sh=s.shapes.add_textbox(Inches(x),Inches(y),Inches(w),Inches(h));f=sh.text_frame;f.clear();f.word_wrap=True;f.margin_left=Inches(.05);f.margin_right=Inches(.05);f.margin_top=Inches(.02);f.margin_bottom=Inches(.02) for i,z in enumerate(t.split('\n')): p=f.paragraphs[0] if i==0 else f.add_paragraph();p.text=z;p.font.name='Aptos';p.font.size=Pt(sz);p.font.bold=b;p.font.color.rgb=c;p.alignment=a;p.space_after=Pt(3) return sh def bullets(s,li,x,y,w,h,sz=17): tx(s,'\n'.join('• '+i for i in li),x,y,w,h,sz) def arrow(s,x1,y1,x2,y2,c=PUR,w=2): z=s.shapes.add_connector(MSO_CONNECTOR.STRAIGHT,Inches(x1),Inches(y1),Inches(x2),Inches(y2));z.line.color.rgb=c;z.line.width=Pt(w);z.line.end_arrowhead=True def hdr(s,t,n): rect(s,0,0,13.333,.55,PUR);tx(s,t,.45,.1,11.7,.3,25,WH,True);tx(s,str(n),12.5,.1,.35,.3,13,WH,True,a=PP_ALIGN.RIGHT);rect(s,.45,7.16,12.4,.02,LAV) def lbl(s,t,x,y,w,h,c=LAV,fs=15): rect(s,x,y,w,h,c,True,RGBColor(190,180,200));tx(s,t,x+.05,y+.08,w-.1,h-.12,fs,DK,True,a=PP_ALIGN.CENTER) def slide(t,n): s=prs.slides.add_slide(blank);hdr(s,t,n);return s # title s=prs.slides.add_slide(blank);rect(s,0,0,13.333,7.5,PUR);rect(s,0,5.9,13.333,1.6,RGBColor(67,43,92));rect(s,.7,.8,.1,4.7,GOLD);tx(s,'BAILEY & LOVE',1.05,.9,4,.3,15,LAV,True);tx(s,'Metabolic response to injury',1.05,1.6,11,1.0,35,WH,True);tx(s,'Basic principles: homeostasis, stress response and recovery',1.05,3.05,10,.45,20,LAV);tx(s,'Prepared only from the supplied textbook pages',1.05,6.55,8,.3,13,WH) # 2 s=slide('Learning objectives and homeostasis',2);tx(s,'Learning objectives',.7,1.0,5,.35,20,PUR,True);bullets(s,['Classical concepts of homeostasis','Metabolic changes in response to injury','Physiological and biochemical changes during injury and recovery'],.8,1.6,5.3,1.8,19);tx(s,'Homeostasis',6.9,1.0,5,.35,20,PUR,True);bullets(s,['Stable internal environment','Co-ordinated physiological processes maintain the organism','Stressors disturb equilibrium and activate compensatory responses'],7,1.6,5.3,1.9,18);rect(s,.8,4.6,11.7,1.25,LAV,True);tx(s,'Surgical practice aims to reduce metabolic stress and return the patient to a stable state in which healing and recovery can proceed.',1.1,4.93,11.1,.55,21,PUR,False,a=PP_ALIGN.CENTER) #3 graded s=slide('The graded nature of the injury response',3);tx(s,'Magnitude and duration increase with injury severity',.7,1.0,6,.32,20,PUR,True);rect(s,.9,1.65,5.4,3.7,WH,False,GREY);arrow(s,1.25,5.0,5.85,5.0,GREY,1);arrow(s,1.25,5.0,1.25,2.05,GREY,1) for pts,col in [([(1.3,4.95),(1.75,2.5),(2.3,2.2),(2.8,3.1),(3.6,4.35),(4.8,4.92)],RED), ([(1.3,4.95),(1.8,3.7),(2.35,3.4),(3.1,4.1),(4.1,4.82)],BLUE), ([(1.3,4.95),(1.75,4.55),(2.5,4.65),(3.5,4.95)],GREEN)]: for a,b in zip(pts,pts[1:]): arrow(s,*a,*b,col,2) tx(s,'Major trauma',3.4,2.35,1.4,.22,13,RED,True);tx(s,'Minor trauma',3.25,3.7,1.4,.22,13,BLUE,True);tx(s,'Normal range',4.3,4.52,1.2,.22,12,GREEN,True);bullets(s,['More severe injury produces a greater response.','Following major trauma, systemic inflammatory response syndrome, hypermetabolism and marked catabolism may occur.','The metabolic response evolves with time.'],7.0,1.6,5.2,2.7,18);lbl(s,'Injury severity and the host response determine the metabolic pattern.',7.1,4.75,4.9,.7,LAV,16) #4 mediators s=slide('Mediators of the metabolic response to injury',4);tx(s,'Classical neuroendocrine pathways',.7,1.0,5.8,.3,20,PUR,True);bullets(s,['Afferent nociceptive pathways transmit signals to the hypothalamus and pituitary.','ACTH release stimulates adrenal cortisol release.','Sympathetic activation causes catecholamine release.','Glucagon ↑, insulin ↓, growth hormone ↑ and prolactin ↑.'],.8,1.55,5.7,3.0,17);tx(s,'Plasma changes',7.05,1.0,4.5,.3,20,PUR,True) for i,(a,b) in enumerate([('ACTH / GH','↑'),('Adrenaline / cortisol','↑'),('Glucagon','↑'),('IL-1 / TNF-α / IL-6 / IL-8','↑'),('Insulin / testosterone','↓')]): y=1.55+i*.55;rect(s,7.1,y,4.4,.5,WH if i%2==0 else LAV,False,LAV);tx(s,a,7.25,y+.1,3.2,.22,15);tx(s,b,10.8,y+.06,.45,.25,20,TEAL if b=='↑' else RED,True,a=PP_ALIGN.CENTER) lbl(s,'Lipolysis ↑ • Hepatic gluconeogenesis ↑ • Proteolysis ↑ • Hypermetabolism',7.15,4.75,4.8,.85,LAV,15) #5 flow diagram s=slide('Integrated neuroendocrine and immune response',5);lbl(s,'Injury',.65,3.1,1.2,.65,RGBColor(250,232,208),17);arrow(s,1.85,3.42,3.15,3.42,RED);lbl(s,'Spinal cord\nafferent pathways',3.2,2.78,1.75,1.25,LAV,14);arrow(s,4.95,3.4,5.85,1.85);arrow(s,4.95,3.4,5.85,4.85);lbl(s,'Hypothalamus\nCRF',5.9,1.45,1.55,.8,RGBColor(217,237,230),15);lbl(s,'Adaptive immune\nsystem',5.9,4.45,1.55,.8,RGBColor(217,237,230),14);arrow(s,7.45,1.85,8.35,1.85,RED);arrow(s,7.45,4.85,8.35,4.85,RED);lbl(s,'Pituitary\nACTH ↑ GH ↑',8.4,1.45,1.55,.8,WH,14);lbl(s,'Innate immune system\nIL-1 / IL-6 / TNF-α ↑',8.4,4.25,1.8,1.05,WH,13);arrow(s,9.95,1.85,10.85,1.85,RED);arrow(s,10.15,4.85,10.85,4.25,RED);lbl(s,'Adrenal\ncortisol ↑\nadrenaline ↑',10.9,1.25,1.45,1.2,RGBColor(252,239,239),13);lbl(s,'Glucagon ↑\nInsulin ↓',10.9,3.9,1.45,.7,RGBColor(252,239,239),14);tx(s,'Metabolic effects: adipocyte lipolysis ↑ | hepatic gluconeogenesis ↑ | skeletal muscle protein degradation ↑ | pyrexia | hypermetabolism',.75,6.45,11.8,.35,15,PUR,True,a=PP_ALIGN.CENTER) #6 inflammation s=slide('Systemic inflammatory response following major injury',6);tx(s,'Initial proinflammatory response',.7,1.0,5.7,.3,20,PUR,True);bullets(s,['Initially driven by IL-1, IL-6 and TNF-α.','Cytokines and acute-phase mediators amplify the response.','The response may become self-perpetuating.'],.8,1.6,5.25,1.8,18);tx(s,'Counter-regulation',7.0,1.0,5.1,.3,20,PUR,True);bullets(s,['Cytokine receptor antagonists and soluble receptors increase.','A balance of pro- and anti-inflammatory activity is required.','Excessive response may evolve into counterinflammatory response syndrome.'],7.1,1.6,5.0,2.0,18);rect(s,.8,4.55,11.7,.95,LAV,True);tx(s,'Cytokines, cortisol, catecholamines and immune pathways form a complex interacting system. Persistent imbalance contributes to complications.',1.05,4.82,11.2,.42,20,PUR,False,a=PP_ALIGN.CENTER) #7 ebb s=slide('Metabolic stress response: the ebb and flow model',7);arrow(s,.95,2.0,12.3,2.0,PUR,2) for x,t,tm,d,c in [(1.0,'Ebb phase','Hours','Shock',BLUE),(4.25,'Flow phase','Days','Catabolism',RED),(8.45,'Recovery','Weeks','Anabolism',GREEN)]: rect(s,x,1.2,2.4,.58,c,True);tx(s,t,x+.1,1.35,2.2,.2,19,WH,True,a=PP_ALIGN.CENTER);tx(s,tm,x+.2,2.35,2,.2,17,GREY,a=PP_ALIGN.CENTER);tx(s,d,x+.2,2.7,2,.25,20,PUR,True,a=PP_ALIGN.CENTER) for x,h,items in [(.85,'Ebb phase',['Begins at injury','Lasts about 24-48 hours','Hypovolaemia, reduced metabolic rate, hypothermia and lactic acidosis']),(4.4,'Flow phase',['Catabolic phase: days','Hypermetabolism, pyrexia and increased oxygen consumption','Followed by an anabolic phase lasting weeks']),(8.75,'Recovery',['Body stores are restored','Anabolism and repair predominate','May require several weeks'])]: tx(s,h,x,3.6,3,.3,19,PUR,True);bullets(s,items,x,4.1,3.2,1.65,16) #8 priorities s=slide('Key catabolic elements of the flow phase',8);lbl(s,'Peripheral tissues\nMuscle • adipose tissue • skin',.7,2.05,3.1,1.2,RGBColor(217,237,230),16);arrow(s,3.85,2.65,5.45,2.65,GOLD,2);lbl(s,'Amino acids\nespecially Gln and Ala',5.55,2.1,2.2,1.1,RGBColor(247,238,205),16);arrow(s,7.8,2.65,9.25,2.65,GOLD,2);lbl(s,'Central tissues\nLiver • immune system • wound',9.35,2.05,3.15,1.2,RGBColor(250,230,230),16);tx(s,'Protein metabolism shifts away from peripheral tissues towards visceral, immune and wound requirements.',1.0,4.05,11.3,.45,21,PUR,a=PP_ALIGN.CENTER) for x,h,it in [(1.0,'Hypermetabolism',['Increased energy expenditure','Increased oxygen consumption']),(4.95,'Skeletal muscle protein metabolism',['Net protein catabolism','Amino-acid release from muscle']),(9.25,'Acute-phase response',['Hepatic protein synthesis shifts','Positive reactants rise'])]:tx(s,h,x,5.05,3,.3,18,PUR,True);bullets(s,it,x,5.5,3.3,1,15) #9 muscle s=slide('Alterations in skeletal-muscle protein metabolism',9);tx(s,'Protein turnover',.7,1.0,4,.3,20,PUR,True);bullets(s,['Muscle protein is continuously synthesised and broken down.','Under normal circumstances, synthesis equals breakdown.','During injury, net muscle protein accretion falls.'],.8,1.55,4.1,2.1,17);tx(s,'Clinical consequences',.7,4.55,4,.3,20,PUR,True);bullets(s,['Marked muscle wasting can impair function and quality of life.','Illness, immobilisation and inadequate nutritional support worsen loss.'],.8,5.05,4.1,1.1,17);lbl(s,'Myofibrillar\nprotein',6.2,1.6,1.8,.8,RGBColor(217,237,230),16);arrow(s,7.1,2.42,8.25,3.05,RED,2);lbl(s,'Caspases, cathepsins\nand calpains',8.15,2.75,2.05,.85,RGBColor(250,232,208),13);arrow(s,10.2,3.2,10.55,4.25,RED,2);lbl(s,'Ubiquitinated\nprotein',10.4,4.2,1.75,.8,LAV,14);arrow(s,11.25,5.0,9.85,5.7,RED,2);lbl(s,'26S proteasome\nATP',8.05,5.35,1.8,.85,RGBColor(247,238,205),14);arrow(s,8.0,5.78,6.6,5.78,RED,2);lbl(s,'Oligopeptides →\nAmino acids',5.2,5.35,1.75,.85,RGBColor(217,237,230),14) #10 hepatic s=slide('Hepatic acute-phase response and insulin resistance',10);tx(s,'Acute-phase response',.7,1.0,5.7,.3,20,PUR,True);bullets(s,['Reprioritisation of body metabolism towards the liver and injured tissues.','Positive reactants rise: C-reactive protein, plasminogen and fibrinogen.','Negative reactants fall: albumin, transferrin and prealbumin.'],.8,1.55,5.45,2.5,17);tx(s,'Insulin resistance',7.0,1.0,5.1,.3,20,PUR,True);bullets(s,['Hyperglycaemia may arise from increased glucose production and reduced glucose uptake.','Insulin resistance is proportional to the magnitude and duration of injury.','Avoid unnecessary fasting and provide early nutritional support.'],7.1,1.55,5.0,2.5,17);lbl(s,'Positive acute-phase reactants\nCRP • plasminogen • fibrinogen',1.0,4.95,5.0,1.0,RGBColor(241,249,243),16);lbl(s,'Negative acute-phase reactants\nAlbumin • transferrin • prealbumin',7.2,4.95,5.0,1.0,RGBColor(252,239,239),16) #11 composition s=slide('Changes in body composition following injury',11);tx(s,'Normal 70-kg male body composition',.7,1.0,5.5,.3,20,PUR,True);y=1.55 for name,h,c in [('Fat',.85,RGBColor(241,225,153)),('Protein',.72,RGBColor(231,202,158)),('Intracellular\nwater',1.7,RGBColor(191,215,233)),('Extracellular\nwater',.8,LAV),('Minerals',.35,RGBColor(184,210,165))]:rect(s,1.2,y,2.1,h,c,False,DK);tx(s,name,1.3,y+h/2-.12,1.9,.3,14,DK,a=PP_ALIGN.CENTER);y+=h bullets(s,['Catabolism decreases fat mass and skeletal muscle mass.','Body weight may paradoxically increase because of expansion of extracellular fluid space.','Protein losses are accompanied by water and sodium retention.'],6.4,1.55,5.25,2.5,18);lbl(s,'Loss of body protein with fluid retention can mask the degree of tissue loss.',6.4,4.8,5.0,.8,LAV,16) #12 factors s=slide('Volume loss and avoidable factors',12);tx(s,'Volume loss',.7,1.0,3.8,.3,20,PUR,True);bullets(s,['Haemorrhage stimulates sympathetic activity, catecholamines, ACTH, cortisol, aldosterone and ADH.','Aldosterone increases renal sodium reabsorption; ADH conserves water.','Salt and water retention may cause oedema.'],.8,1.55,3.9,2.8,16);tx(s,'Avoidable factors',5.0,1.0,3.2,.3,20,PUR,True);bullets(s,['Continuing haemorrhage','Hypothermia','Sepsis','Tissue underperfusion','Starvation','Immobility'],5.1,1.55,2.7,2.8,17);tx(s,'Compounding factors',8.75,1.0,3.9,.3,20,PUR,True);bullets(s,['Hypothermia','Starvation','Tissue oedema','Systemic inflammation and underperfusion','Immobility'],8.85,1.55,3.6,2.7,16);lbl(s,'Wound • hypothermia • sepsis • pain',.9,5.3,2.0,.75,RGBColor(250,232,208),14);arrow(s,2.95,5.67,4.1,5.67,RED);lbl(s,'Adreno-sympathetic\nactivation',4.15,5.27,2,.8,LAV,14);arrow(s,6.2,5.67,7.3,5.67,RED);lbl(s,'Acute-phase response\nInsulin resistance',7.35,5.27,2.25,.8,LAV,13);arrow(s,9.65,5.67,10.7,5.67,RED);lbl(s,'Catabolism +',10.75,5.3,1.5,.75,RGBColor(252,239,239),15) #13 ERAS s=slide('Concepts behind enhanced recovery after surgery',13);tx(s,'Aim',.7,1.0,5.5,.3,20,PUR,True);bullets(s,['Traditional perioperative care may reinforce the stress response.','Reduce unnecessary adverse metabolic effects and promote recovery.','Operative magnitude, pain, fasting, fluids, immobility and nutrition influence the response.'],.8,1.55,5.35,2.3,18);tx(s,'Proactive measures from the supplied pages',7.0,1.0,5.2,.3,20,PUR,True);bullets(s,['Minimise surgical stress where possible','Avoid prolonged fasting and excessive intravenous saline','Use effective analgesia','Maintain normothermia','Avoid periods of starvation','Encourage early mobilisation'],7.1,1.55,4.9,2.8,16);arrow(s,1.2,6.35,5.8,6.35,GREY,1);arrow(s,1.2,6.35,1.2,4.65,GREY,1) for pts,c in [([(1.3,5.0),(1.8,5.6),(2.65,6.05),(3.55,6.05),(4.3,5.55),(5.4,4.95)],BLUE), ([(1.3,5.0),(1.8,5.35),(2.45,5.6),(3.2,5.6),(3.85,5.25),(4.35,4.8),(5.3,4.75)],GREEN)]: for a,b in zip(pts,pts[1:]):arrow(s,*a,*b,c,2) tx(s,'Traditional care',2.2,6.08,1.5,.2,12,BLUE,True);tx(s,'Multimodal ERAS intervention',3.6,4.5,2,.2,12,GREEN,True) #14 s=slide('Summary',14);items=['Homeostasis is disturbed by injury; neuroendocrine and immune responses follow.','Magnitude and duration increase with injury severity.','The ebb phase is followed by a hypermetabolic, catabolic flow phase and later recovery.','Muscle protein is mobilised to support central tissues, immune function and the wound.','Catabolism, insulin resistance, fluid retention and acute-phase changes are interconnected.','Reducing avoidable stressors supports recovery after surgery.'] y=1.0 for i,t in enumerate(items,1):rect(s,.85,y,.55,.55,PUR,True);tx(s,str(i),.85,y+.09,.55,.25,17,WH,True,a=PP_ALIGN.CENTER);tx(s,t,1.65,y+.08,10.6,.35,18,DK);y+=.87 tx(s,'All content is based only on the supplied Bailey & Love textbook pages.',.8,6.55,11.7,.25,13,GREY,a=PP_ALIGN.CENTER) prs.save(P) print(P) PY python "/tmp/workspace/bailey-ppt/src/make.py" && python - <<'PY' from pptx import Presentation p='/tmp/workspace/bailey-ppt/output/Bailey_Metabolic_Response_to_Injury.pptx' r=Presentation(p); print('slides',len(r.slides)) PY

~/bailey-ppt/output

~/

~/bailey-metabolic-response-ppt

Bailey and Love Short Practice of Surgery metabolic response to injury figures ebb flow model

python - <<'PY' from PIL import Image,ImageDraw from pathlib import Path src=Path('/tmp/workspace/bailey-metabolic-response-ppt/assets') ims=[] for p in sorted(src.glob('*_upright.jpg')): im=Image.open(p); im.thumbnail((180,240));ims.append((p.name,im.copy())) out=Image.new('RGB',(900,600),'white');d=ImageDraw.Draw(out) for i,(n,im) in enumerate(ims): x=(i%5)*180;y=(i//5)*300;out.paste(im,(x,y));d.text((x+3,y+245),n.replace('_upright.jpg',''),fill='black') out.save('/tmp/workspace/bailey-metabolic-response-ppt/assets/contact.jpg',quality=70) PY

python - <<'PY' from PIL import Image from pathlib import Path for name in ['IMG_2437','IMG_2438','IMG_2439','IMG_2444','IMG_2445']: im=Image.open('/tmp/workspace/bailey-metabolic-response-ppt/assets/'+name+'_upright.jpg') print(name,im.size) PY for f in /tmp/workspace/bailey-metabolic-response-ppt/assets/IMG_2437_upright.jpg /tmp/workspace/bailey-metabolic-response-ppt/assets/IMG_2438_upright.jpg; do tesseract "$f" stdout 2>/dev/null | head -10; done

python - <<'PY' from PIL import Image, ImageOps from pathlib import Path src=Path('/tmp/workspace/attachments/9b268547-7cfe-485c-a707-d5a3555015a7') out=Path('/tmp/workspace/bailey-metabolic-response-ppt/assets/corrected');out.mkdir(exist_ok=True) for p in sorted(src.glob('*.jpg')): im=Image.open(p) print(p.name,'raw',im.size,'exif',im.getexif().get(274)) im=ImageOps.exif_transpose(im) print('transpose',im.size) im.save(out/p.name,quality=90) PY

python - <<'PY' from PIL import Image,ImageDraw from pathlib import Path src=Path('/tmp/workspace/attachments/9b268547-7cfe-485c-a707-d5a3555015a7') out=Path('/tmp/workspace/bailey-metabolic-response-ppt/assets/preview');out.mkdir(exist_ok=True) for p in [src/'IMG_2437.jpg',src/'IMG_2438.jpg',src/'IMG_2439.jpg',src/'IMG_2444.jpg',src/'IMG_2445.jpg']: im=Image.open(p); im.thumbnail((480,480));im.save(out/p.name,quality=55) PY

mkdir -p "/tmp/workspace/bailey-corrected-ppt/output" "/tmp/workspace/bailey-corrected-ppt/src" && cat > "/tmp/workspace/bailey-corrected-ppt/src/create_fixed.py" <<'PY' from pptx import Presentation from pptx.util import Inches, Pt from pptx.enum.shapes import MSO_SHAPE from pptx.enum.text import PP_ALIGN from pptx.dml.color import RGBColor from PIL import Image from pathlib import Path ROOT=Path('/tmp/workspace/bailey-metabolic-response-ppt/assets') OUT=Path('/tmp/workspace/bailey-corrected-ppt/output/Bailey_Metabolic_Response_to_Injury_FIXED.pptx') # create render-friendly upright book pages upr=ROOT/'book_pages'; upr.mkdir(exist_ok=True) for n in range(2436,2446): src=Path(f'/tmp/workspace/attachments/9b268547-7cfe-485c-a707-d5a3555015a7/IMG_{n}.jpg') im=Image.open(src).rotate(-90, expand=True) im.save(upr/f'IMG_{n}.jpg', quality=93) prs=Presentation();prs.slide_width=Inches(13.333);prs.slide_height=Inches(7.5);blank=prs.slide_layouts[6] PUR=RGBColor(78,52,108); LAV=RGBColor(235,230,241); DK=RGBColor(48,43,57); WH=RGBColor(255,255,255); GOLD=RGBColor(203,164,86); GREY=RGBColor(105,101,110) def rect(s,x,y,w,h,c,round=False,lc=None): sh=s.shapes.add_shape(MSO_SHAPE.ROUNDED_RECTANGLE if round else MSO_SHAPE.RECTANGLE,Inches(x),Inches(y),Inches(w),Inches(h));sh.fill.solid();sh.fill.fore_color.rgb=c;sh.line.color.rgb=lc or c;return sh def text(s,t,x,y,w,h,size=18,c=DK,b=False,a=PP_ALIGN.LEFT): sh=s.shapes.add_textbox(Inches(x), Inches(y), Inches(w), Inches(h));tf=sh.text_frame;tf.clear();tf.word_wrap=True;tf.margin_left=Inches(.05);tf.margin_right=Inches(.05);tf.margin_top=Inches(.02);tf.margin_bottom=Inches(.02) for i,z in enumerate(t.split('\n')): p=tf.paragraphs[0] if i==0 else tf.add_paragraph();p.text=z;p.font.name='Aptos';p.font.size=Pt(size);p.font.bold=b;p.font.color.rgb=c;p.alignment=a;p.space_after=Pt(3) return sh def bullet(s,items,x,y,w,h,size=16): text(s,'\n'.join('• '+a for a in items),x,y,w,h,size) def hdr(s,title,n): rect(s,0,0,13.333,.55,PUR);text(s,title,.48,.1,11.6,.28,24,WH,True);text(s,str(n),12.45,.1,.35,.25,13,WH,True,PP_ALIGN.RIGHT);rect(s,.48,7.15,12.3,.02,LAV) def add_page(s,num): # Portrait photo is placed whole, with border. no editable arrows, image is fixed rect(s,.55,.78,4.18,5.98,WH,True,RGBColor(203,196,213));s.shapes.add_picture(str(upr/f'IMG_{num}.jpg'), Inches(.68), Inches(.9), width=Inches(3.93), height=Inches(5.74)) def page_slide(num,title,kicker,points,box_title,box_lines,slide_no): s=prs.slides.add_slide(blank);hdr(s,title,slide_no);add_page(s,num);text(s,kicker,5.15,.95,7.3,.3,17,PUR,True);text(s,'Book page reproduced from your supplied photo',.7,6.82,3.9,.18,9,GREY) bullet(s,points,5.2,1.45,7.25,2.5,17);rect(s,5.15,4.35,7.3,1.45,LAV,True);text(s,box_title,5.42,4.58,6.8,.24,17,PUR,True);bullet(s,box_lines,5.43,4.93,6.6,.65,14) return s # title s=prs.slides.add_slide(blank);rect(s,0,0,13.333,7.5,PUR);rect(s,0,5.75,13.333,1.75,RGBColor(64,42,88));rect(s,.72,.85,.12,4.45,GOLD);text(s,'BAILEY & LOVE',1.08,.92,4,.25,14,LAV,True);text(s,'Metabolic response to injury',1.08,1.62,10.7,.75,34,WH,True);text(s,'Corrected visual edition',1.1,2.72,5,.35,20,LAV);text(s,'Figures, graphs and chapter pages are included as fixed images from the photos you provided.',1.1,3.55,9.8,.55,18,WH);text(s,'No editable arrows or movable diagram elements.',1.1,6.45,7,.25,14,LAV) # content image pages page_slide(2436,'Basic concepts in homeostasis','Homeostasis and response to injury',['Injury alters body composition and metabolic balance.','The physiological response seeks to restore stability.','Optimal perioperative care reduces stress and supports recovery.'],'Core message',['Homeostasis underpins effective surgical care.','The surgical response is both neuroendocrine and metabolic.'],2) page_slide(2437,'The graded injury response','Metabolic graphs from Bailey & Love',['The response is greater with more severe injury.','Major trauma may produce hypermetabolism and marked catabolism.','The response changes over time rather than remaining static.'],'What the graphs show',['Metabolic rate rises with injury severity.','Nitrogen loss increases after trauma, especially major trauma.'],3) page_slide(2438,'Mediators of the metabolic response','Integrated neuroendocrine and immune response figure',['Afferent signals activate hypothalamic, pituitary and sympathetic pathways.','ACTH, cortisol, catecholamines and glucagon rise.','Insulin and testosterone fall, while cytokines shape the systemic response.'],'Metabolic effects listed in the figure',['Lipolysis ↑ • gluconeogenesis ↑ • protein degradation ↑','Hepatic acute-phase protein synthesis ↑ • pyrexia • hypermetabolism'],4) page_slide(2439,'The ebb and flow model','Cuthbertson phases and major muscle pathways',['Ebb phase: hours, shock and reduced metabolic activity.','Flow phase: days, catabolism and increased metabolic demand.','Recovery: weeks, anabolic restoration of stores.'],'Phase table',['Ebb: hypovolaemia, hypothermia and reduced cardiac output.','Flow: hypermetabolism and protein catabolism.','Recovery: repair and anabolism predominate.'],5) page_slide(2440,'Flow-phase catabolism','Protein mobilisation to central tissues',['The flow phase directs metabolic resources towards central tissues.','Hypermetabolism increases energy expenditure.','Peripheral tissues release amino acids, especially glutamine and alanine.'],'Protein metabolism',['Muscle protein synthesis and breakdown occur continuously.','Critical illness promotes net protein loss and skeletal-muscle wasting.'],6) page_slide(2441,'Skeletal muscle protein wasting','Ubiquitin-proteasome pathway figure',['The supplied figure shows breakdown of myofibrillar protein.','Caspases, cathepsins and calpains begin degradation.','Ubiquitination and the 26S proteasome produce oligopeptides and amino acids.'],'Clinical impact',['Muscle wasting provides substrates for the metabolic response.','It may impair muscle function and recovery.'],7) page_slide(2442,'Body composition and insulin resistance','Normal body-composition diagram and acute-phase response',['Critical illness causes loss of body protein and skeletal muscle.','Fluid retention can make body weight appear increased.','Insulin resistance results from increased glucose production and decreased uptake.'],'Acute-phase response',['Positive reactants: CRP, plasminogen and fibrinogen.','Negative reactants: albumin, transferrin and prealbumin.'],8) page_slide(2443,'Changes following critical illness','Weight loss, volume loss and avoidable factors',['Catabolism decreases fat and skeletal-muscle mass.','Extracellular fluid expansion may mask tissue loss.','Haemorrhage activates sympathetic and hormonal sodium and water retention.'],'Avoidable factors in the chapter',['Continuing haemorrhage • hypothermia • sepsis','Tissue underperfusion • starvation • immobility'],9) page_slide(2444,'Factors that compound injury response','Fixed book flowchart: immobilisation and starvation',['Wound, hypothermia, sepsis and pain drive neuroendocrine and cytokine responses.','The book flowchart links these stressors to pyrexia, insulin resistance, futile substrate cycling and muscle protein degradation.','The diagram is included as an image so its arrows remain correctly aligned.'],'Supportive care priorities',['Prevent unnecessary fasting and immobilisation.','Maintain normothermia and control pain.'],10) page_slide(2445,'Enhanced recovery after surgery','Recovery curve and proactive measures',['Multimodal ERAS programmes are shown to reduce the functional decline after surgery.','They support earlier recovery with less metabolic stress.','The chapter highlights effective analgesia, normothermia, nutrition and early mobilisation.'],'Summary box 1.11',['Minimise surgical stress.','Avoid periods of starvation.','Early mobilisation and appropriate analgesia.'],11) # clear presentation tables no connectors s=prs.slides.add_slide(blank);hdr(s,'Presentation table: phases of response to injury',12) cols=[(.7,2.4,'Phase'),(3.1,2.2,'Timing'),(5.4,3.25,'Dominant pattern'),(8.75,3.85,'Features from the supplied chapter')] for x,w,t in cols:rect(s,x,1.15,w,.55,PUR);text(s,t,x+.06,1.31,w-.12,.2,15,WH,True,PP_ALIGN.CENTER) rows=[('Ebb phase','Hours','Shock','Hypovolaemia, reduced metabolic rate, reduced cardiac output, hypothermia and lactic acidosis'),('Flow phase','Days','Catabolism','Hypermetabolism, raised cardiac output, pyrexia, leucocytosis and increased oxygen consumption'),('Recovery','Weeks','Anabolism','Body stores are restored; repair and recovery predominate')] y=1.7 for j,row in enumerate(rows): xvals=[.7,3.1,5.4,8.75]; ws=[2.4,2.2,3.25,3.85] for x,w,val in zip(xvals,ws,row):rect(s,x,y,w,1.15,WH if j%2==0 else LAV,False,RGBColor(211,205,218));text(s,val,x+.1,y+.14,w-.2,.8,15,DK,False,PP_ALIGN.CENTER) y+=1.15 text(s,'Table reconstructed only from the ebb-and-flow figure and accompanying supplied text.',.75,6.2,11.4,.25,12,GREY,False,PP_ALIGN.CENTER) s=prs.slides.add_slide(blank);hdr(s,'Presentation table: factors that compound the response',13) cols=[(.75,3.0,'Factor'),(3.8,4.0,'Book pathway / consequence'),(7.9,4.55,'Practical direction stated in chapter')] for x,w,t in cols:rect(s,x,1.15,w,.55,PUR);text(s,t,x+.05,1.31,w-.1,.2,15,WH,True,PP_ALIGN.CENTER) rows=[('Continuing haemorrhage','Volume loss and hormonal water/sodium conservation','Control the source and avoid ongoing hypoperfusion'),('Hypothermia','Increased metabolic stress response and catabolism','Maintain normothermia'),('Starvation','Pyrexia, acute-phase response, insulin resistance and muscle protein degradation','Avoid unnecessary fasting; early nutritional support'),('Immobility','Contributes to muscle wasting and catabolic response','Encourage early mobilisation')] y=1.7 for j,row in enumerate(rows): for x,w,val in zip([.75,3.8,7.9],[3.0,4.0,4.55],row):rect(s,x,y,w,1.02,WH if j%2==0 else LAV,False,RGBColor(211,205,218));text(s,val,x+.1,y+.13,w-.2,.7,14,DK,False,PP_ALIGN.CENTER) y+=1.02 text(s,'This table uses only the avoidable-factor and enhanced-recovery sections shown in your pages.',.75,6.2,11.6,.25,12,GREY,False,PP_ALIGN.CENTER) # final s=prs.slides.add_slide(blank);hdr(s,'Summary',14) items=['Severity of injury determines the magnitude and duration of the metabolic response.','Neuroendocrine and immune mediators create a systemic stress response.','The response passes through ebb, catabolic flow and recovery phases.','Muscle protein, hepatic acute-phase changes, insulin resistance and fluid retention are linked.','The chapter supports reduction of avoidable stressors and enhanced recovery measures.'] y=1.1 for i,a in enumerate(items,1):rect(s,.9,y,.55,.55,PUR,True);text(s,str(i),.9,y+.1,.55,.22,17,WH,True,PP_ALIGN.CENTER);text(s,a,1.7,y+.09,10.6,.32,18,DK);y+=.87 text(s,'All diagrams shown in this corrected deck are fixed textbook-page images from the photos you supplied.',.85,6.55,11.6,.25,13,GREY,False,PP_ALIGN.CENTER) prs.save(OUT) print(OUT, len(prs.slides)) PY python "/tmp/workspace/bailey-corrected-ppt/src/create_fixed.py" && python - <<'PY' from pptx import Presentation p='/tmp/workspace/bailey-corrected-ppt/output/Bailey_Metabolic_Response_to_Injury_FIXED.pptx' q=Presentation(p); assert len(q.slides)==14; print('verified slides',len(q.slides)) PY

~/bailey-corrected-ppt/output

surgical injury metabolic response

Bailey Love metabolic response to injury ebb flow phase chapter

surgical injury metabolic response

Bailey Love metabolic response to injury ebb flow phase chapter