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The northern and central Adriatic Sea represents an important spawning and aggregation area for common sole ( Solea solea ) and provides for around 20% of the Mediterranean landings. In this area, this resource is mainly exploited with rapido trawl and set nets. The stock is not yet depleted and faces a situation of growth overfishing. The comparison between the spatial distribution by age of S. solea and the geographic patterns of the rapido trawl fishing effort evidenced an overlapping of this fishing activity with the area where juveniles concentrate (age groups 0–2). The majority of spawners inhabits specific offshore areas, here defined as ‘sole sanctuaries’, where high concentrations of debris and benthic communities make difficult trawling with rapido . The aim of this study was to evaluate existing spatial management regimes and potential new spatial and temporal closures in the northern and central Adriatic Sea using a simple modelling tool. Two spatial simulations were carried out in order to verify the effectiveness of complementary methods for the management of fisheries: the ban of rapido trawling from October to December within 6 nautical miles and 9 nautical miles of the Italian coast. The focus of the simulation is that the effort of the rapido trawl is moved far from the coast during key sole recruitment periods, when the juveniles are moving from the inshore nursery area toward the offshore feeding grounds. The management scenarios showed that a change in selectivity would lead to a clear increase in the spawning stock biomass and an increase in landings of S. solea in the medium-term. The rapido trawl activity could be managed by using a different logic, bearing in mind that catches and incomes would increase with small changes in the spatial pattern of the fishing effort. The present study highlights the importance of taking into account spatial dimensions of fishing fleets and the possible interactions that can occur between fleets and target species, facilitating the development of control measures to achieve a healthy balance between stock exploitation and socio-economic factors.

The purpose of this retrospective review of the charts of 51 Jehovah's Witness patients, who underwent surgery without blood transfusions, was to compare two study groups (major surgery vs minor-medium surgery).We compared the following variables: age, sex, length of stay, type of surgical operation, use of intraoperative red cell salvaging devices, hemodilution, number of drainages and their stay, postoperative blood loss, complications, need of reoperation and mortality rate. Between medical variables we focused on blood production therapy and nutritional support (administration of iron, folate, erythropoietin and albumin) and blood tests (at the first day of admission; intraoperative; at the first postoperative day; at the discharge).In the two study groups, we detected statistically significant differences in the following variables: total of postoperative blood loss (p0.00001), complications rate (p = 0.0122) and in Hgb values (intraoperative: p = 0.0197; at the first postoperative day: p = 0.0028; at the discharge: p = 0.0100).The aims of a bloodless surgery program are: 1) minimize blood loss, reducing iatrogenic anemia and intraoperative hemorrhage loss; 2) maximize blood production by administration of erythropoietin, iron and folate; 3) maximize cardiac output by alternatives to blood transfusions, as crystalloids, colloids and blood substitutes; 4) increase oxygen content; 5) decrease metabolic rate. We focused on advantages and disadvantages of the suggested procedures. Most interesting techniques are the normovolemic hemodilution and the intraoperative red cell salvaging devices, indispensable in emergency.A close team-work between surgeons, anesthesiologists and hematologists is determinant in a reference center that guarantees experience, organization, professionality, respect for the patients' will and, above all, low morbidity and mortality rates, as those reported by our series.

It has been reported that patients who refuse blood transfusions, such as Jehovah's witnesses, can undergo major surgery. In a review of the literature, however, we critically examined the severity of anaemia in relation to operative mortality and morbidity rates. We report three cases of Jehovah's witnesses who underwent major surgery and presented complication during the postoperative period. Case 1: a 50-year-old man with oesophageal achalasia who underwent Heller's myotomy and Nissen's fundoplication. The postoperative period was complicated by massive haemorrhage and the patient was reoperated on postoperative day 1. After four years, he underwent total oesophagectomy because of severe chronic oesophagitis. On postoperative day 13 the patient suffered anteroseptal myocardial ischaemia, which was treated with medical therapy. Case 2: a 40-year-old man, admitted for ulcerative rectocolitis, who underwent total colectomy. On postoperative day 1 he presented massive haemorrhage and shock. He was reoperated and the postoperative period was complicated by myocardial ischaemia, renal failure and an enterocutaneous fistula. Case 3: a 65-year-old woman with ulcerative rectocolitis who underwent total colectomy and a temporary ileostomy. She suffered venous thrombosis of the lower limbs and pulmonary oedema. The patient died 14 months after surgery as a result of massive haemolysis by cryoagglutinins and cardiac arrest.