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Introduction: Patients undergoing emergency abdominal surgery for inflammatory bowel disease (IBD) are a complex cohort who are relatively poorly represented in published literature. This is partly due to the lack of consensus of the definition of the term emergency in IBD surgery. There is ongoing and recent work defining clinical urgency for unplanned surgical procedures and categorizing the high‐risk surgical patient. This paper aims to report the difference in patient metrics and risks as recorded by the National Emergency Laparotomy Audit (NELA). Methods: Complete patient data, including histology, were available in the NELA database between 2013 and 2016. Urgency categories recorded by NELA are <2 h, 2–6 h, 6–18 h, and >18 h. Patient characteristics, physiology, biochemistry, and outcomes are reported according to these urgency categories with regression analysis used to compare differences between them. Results: Mortality in Crohn's disease (CD) ranged from 1.4% in the >18 h urgency to 14.6% in the most urgent. In ulcerative colitis (UC), this range was from 3.1% to 14.8%. In both CD and UC, there were significant trends in hemodynamic instability, serum white cell count, serum electrolytes and creatinine, and outcome measures length of stay and unplanned return to theater. Conclusions: Patients having emergency surgery for IBD are not a single cohort when considering physiology, blood biochemistry, or most importantly, outcomes. Risk counseling and management should reflect this. Hemodynamic changes are subtle and may be missed in this cohort. [ABSTRACT FROM AUTHOR]

Aim: The medical management of inflammatory bowel disease (IBD) is rapidly progressing; however, many patients with the disease still require surgery. Often this is done as an emergency. Initiatives such as the National Emergency Laparotomy Audit have shown how evidence‐based emergency surgery improves outcomes for the patient. The aim of this scoping review is to describe the current evidence base on risk stratification in emergency abdominal surgery for IBD. Methods: A literature search, abstract and full paper screening resulted in 17 articles representing 63 472 patients from seven countries. Results: It is likely that age, the American Society of Anesthesiologists grade, comorbidity and organ dysfunction play a similar role in risk stratification in IBD patients as in other emergency abdominal surgery cohorts. However, the reporting of what is considered an IBD emergency is variable. Six studies include clear definitions of emergency in our study. The range of what is considered an emergency is within 12 h of admission to any time within an unplanned admission. Conclusion: To have data driven, evidence‐based emergency surgical practice in IBD we need consistency of reporting, including the definitions of emergency and urgency. Core descriptor sets in IBD would be valuable. [ABSTRACT FROM AUTHOR]

Introduction: Emergency laparotomy may be required in patients with inflammatory bowel disease (IBD). NELA is the largest prospectively maintained database of adult emergency laparotomies in England and Wales and includes clinical urgency of the cases. The impact of surgeon subspeciality on outcomes after emergency laparotomy for IBD is unclear. We have investigated this association, according to the degree of urgency in IBD emergency laparotomy, including the effect of minimally invasive surgery (MIS). Methods: Adults with IBD in the NELA database between 2013 and 2016 were included. Surgeon subspeciality was colorectal or non-colorectal. Urgencies are 'Immediate', '2–6 h', '6–18 h' and '18–24 h'. Logistic regression was used to investigate in-patient mortality and post-operative length of stay (LOS). Results: There was significantly reduced mortality and LOS in IBD patients who were operated on by a colorectal surgeon in the least urgent category of emergency laparotomies; Mortality adjusted OR 2.99 (CI 1.2–7.8) P = 0.025, LOS IRR 1.18 (CI 1.02–1.4) P = 0.025. This association was not seen in more urgent categories. Colorectal surgeons were more likely to use MIS, P < 0.001, and MIS was associated with decreased LOS in the least urgent cohort, P < 0.001, but not in the other urgencies. Conclusions: We found improved outcomes in the least urgent cohort of IBD emergency laparotomies when operated on by a colorectal surgeon in comparison to a non-colorectal general surgeon. In the most urgent cases, there was no benefit in the operation being performed by a colorectal surgeon. Further work on characterising IBD emergencies by urgency would be of value. [ABSTRACT FROM AUTHOR]

Soybeans were grown at three CO2 concentrations in outdoor growth chambers and at two concentrations in controlled-environment growth chambers to investigate the interactive effects of CO2, temperature and leaf-to-air vapour pressure difference (LAVPD) on stomatal conductance. The decline in stomatal conductance with CO2 was a function of both leaf temperature and LAVPD. In the field measurements, stomatal conductance was more sensitive to LAVPD atlow CO2 at 30 °C but not at 35 °C. There was also a direct increase in conductance with temperature, which was greater at the two elevated carbon dioxide concentrations. Environmental growthchamber results showed that the relative stomatal sensitivity to LAVPD decreased with both leaf temperature and CO2. Measurements in the environmental growth chamber were also performed at the opposing CO2, and these experiments indicate that the stomatal sensitivity to LAVPD was determined more by growth CO2 than by measurement CO2. Two models that describe stomatal responses to LAVPD were compared with the outdoor data to evaluate whether these models described adequately the interactive effects of CO2, LAVPD and temperature. [ABSTRACT FROM AUTHOR]

Three types of observations were used to test the hypothesis that the response of stomatal conductance to a change in vapour pressure deficit is controlled by whole-leaf transpiration rate or by feedback from leaf water potential. Varying the leaf water potential of a measured leaf by controlling the transpiration rate of other leaves on the plant did not affect the response of stomatal conductance to vapour pressure deficit in Glycine max. In three species, stomatal sensitivity to vapour pressure deficit was eliminated when measurements were made at near-zero carbon dioxide concentrations, despite the much higher transpiration rates of leaves at low carbon dioxide. In Abutilon theophrasti, increasing vapour pressure deficit sometimes resulted in both decreased stomatal conductance and a lower transpiration rate even though the response of assimilation rate to the calculated substomatal carbon dioxide concentration indicated that there was no 'patchy' stomatal closure at high vapour pressure deficit in this case. These results are not consistent with stomatal closure at high vapour pressure deficit caused by increased whole-leaf transpiration rate or by lower leaf water potential. The lack of response of conductance to vapour pressure deficit in carbon dioxide-free air suggests that abscisic acid may mediate the response. [ABSTRACT FROM AUTHOR]

Soybean plants were grown continuously at 350 and 700 cm3 m-3 CO2 at constant temperature. Respiration rates of third trifoliolate leaves were measured at the growth CO2 concentration for the whole dark period from 5 d before through to 5 d after full area expansion. The short-term response of respiration rate to the measurement CO2 concentration was also determined at each age. Respiration rates per unit of dry mass declined with age and were significantly less at a given age or RGR in leaves grown and measured at the elevated CO2. The difference in respiration rate was largest in mature leaves and resulted from the different measurement CO2 concentrations. The respiratory costs of the tissue synthesis, estimated from the elemental composition of the tissue, did not differ substantially between CO2 treatments. The response of respiration rate to carbon dioxide concentration was not strongly affected by the form of nitrogen supplied. Maintenance respiration calculated by subtracting growth respiration from total respiration was negative in rapidly growing leaves for both CO2 treatments. This Indicates that CO2 efflux in the dark does not accurately reflect the average 24 h rate of energy expenditure on growth and maintenance for soybean leaves. [ABSTRACT FROM AUTHOR]

Experiments were performed to determine if growth at elevated partial pressure of CO2 altered the sensitivity of leaf water vapour conductance and rate of CO2 assimilation to the leaf-to-air difference in the partial pressure of water vapour (Δw). Comparisons were made between plants grown and measured at 350 and 700 μPa Pa-1 partial pressures of CO2 for amaranth, soybean and sunflower grown in controlled environment chambers, soybean grown outdoors in pots, and orchard grass grown in field plots. In amaranth, soybean and orchard grass, both the absolute and the relative sensitivity of conductance to Δw at the leaf surface were less in plants grown and measured at the elevated CO2. In sunflower, there was no change in the sensitivity of conductance to Δw for the two CO2 partial pressures. Tests in soybeans and amaranth showed that the change in sensitivity resulted from elevated CO2 during the measurement of the Δw response. Assimilation rate of CO2 was not altered by Δw in amaranth, which has C4 metabolism. In sunflower, the assimilation rate of plants grown and measured at elevated CO2 was insensitive to Δw, consistent with the response of assimilation rate to intercellular CO2 partial pressure in the prevailing range. In soybean, the sensitivity of assimilation rate to Δw was not different between CO2 treatments, in contrast to what would be expected from the response of assimilation rate to intercellular CO2 partial pressure. [ABSTRACT FROM AUTHOR]

Leaf area expansion, photosynthetic carbon dioxide uptake and leaf dry mass accumulation were compared for expanding leaves of well-watered soybean (Glycine max [L.] Merr.) plants, mildly dehydrated plants and well-watered plants treated with abscisic acid (ABA). Both ABA treatment and dehydration reduced area expansion in the light and over a 24 h period without decreasing the photosynthetic rates of expanding leaves. Dry mass accumulation during the light was less in ABA-treated and water-stressed leaves than in control leaves, with no differences among treatments in leaf mass per unit of area. ABA treatment and water stress both increased export of carbon from expanding leaves in the light. ABA applied near the end of the light period also increased export of carbon during the following dark period. However, it is unlikely that decreased availability of photosynthate caused slow expansion in the ABA and dehydration treatments, because expansion rates were not slowed in plants kept in dim light, even though photosynthetic rates and dry mass accumulation rates were greatly reduced. The data suggest that ABA may mediate the effects of mild dehydration on leaf area expansion and partitioning of photosynthate. [ABSTRACT FROM AUTHOR]

Gas exchange measurements were made on single leaves of three C3 and one C4 species at air speeds of 0.4 and 4.0 m s-1 to determine if boundary layer conductance substantially affected the sub- stomatal pressure of carbon dioxide. Boundary layer conductances to water vapour were 0.4 to 0.5 mol m-2 s-1 at the lower air speed, and 1.2 to 1.5 mol m-2 s-1 at the higher air speed. Substonmatal carbon dioxide pressures were about 5 Pa lower at low boundary layer conductance in the C3 species, and about 3 Pa lower in the C4 species when measurements were made at high and moderate photosynthetic photon flux densities. No evidence of stomatal adjustment to altered boundary layer conductance was found. Photosynthetic rates at high photon flux densities were reduced by about 20% at the low air speed in the C3 species. The commonly reported values of substomatal carbon dioxide pressure for C3 and C3 species were found to occur only when measurements were made at the higher air speed. [ABSTRACT FROM AUTHOR]

Leaf conductance responses to leaf to air water vapour partial pressure difference (VPD) have been measured at air speeds of 0.5 and 3.0 ms-1 in single attached leaves of three species in order to test the hypothesis that leaf conductance response to VPD is controlled by evaporation from the outer surface of the epidermis, rather than by evaporation through stomata. Total conductance decreased linearly with increasing VPD at both air speeds, but was decreased 1.6-3.0 times as much as by a given increase in VPD at high than at low air speed, depending on species. In all species the relationship between leaf conductance and the gradient for evaporation from the epidermis was the same at both values of boundary layer conductance, supporting the hypothesis that direct epidermal evaporation controls stomatal guard cell behaviour in responses of stomata to VPD in these species. [ABSTRACT FROM AUTHOR]