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Elemental mercury impaction in the appendix can cause subsequent local and systemic complications. We present a case of a teenage boy who ingested approximately 10 mL of elemental mercury, resulting in residual mercury sequestration in the appendix after conservative management. We performed laparoscopic appendectomy to remove the residual mercury. The patient made a complete clinical recovery without adverse events related to mercury poisoning over the 6-month follow-up. We highlight the advantages of laparoscopic appendectomy, abdominal computed tomography (CT), negative pressure operating rooms, and surgeon protection to improve surgical success rates. This case report adds to the literature on the management of elemental mercury impaction in the appendix and provides valuable insights for clinical decision-making.

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The infectious pathogen-laden aerosols generated by infected patients have a significant impact on the safety of surgical staff in highly clean negative-pressure operating rooms. Understanding the transmission characteristics of infectious pathogen-laden aerosols is therefore essential. Therefore, in this study, we conducted experiments in a full-size negative-pressure operating room, and the Phi-X174 phage was used as a bioaerosol release source to investigate the migration and deposition of bioaerosols. The high-concentration spatial regions and high-concentration deposition surfaces of the bioaerosols in the operating room were determined. The results showed that there was a high concentration of bioaerosols in the vortex region below the medical lamp for extended periods of time. Three surgical staff members close to the patient's surgical site had high bioaerosol concentrations at their facial sampling points, with the highest concentration reaching 16,553 PFU/m³ . At the end of bioaerosol generation, 99.9% of the bioaerosols were discharged within 10 mins. The bioaerosol deposition rates per unit area were high at 1.48%/m2, 0.46%/m2 and 1.79%/m2 for the central control panel, storage cabinet, and door surface, respectively. This research can be used as a scientific reference for controlling bioaerosols and determining key disinfection parts in a negative-pressure operating room.

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The purpose of this study was to reveal the exposure level of surgical staff to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from the patient's nose and wound during operations on COVID-19 patients. The tracer gas N2O is used to simulate SARS-CoV-2 from the patient's nose and wound. In this study, concentration levels of tracer gas were measured in the breathing zones of these surgical staff in the operating room under three pressure difference conditions: -5 pa-15 pa and -25 pa compared to the adjunction room. These influencing factors on exposure level are analyzed in terms of ventilation efficiency and the thermal plume distribution characteristics of the patient. The results show that the assistant surgeon faces 4 to 12 times higher levels of exposure to SARS-CoV-2 than other surgical staff. Increasing the pressure difference between the OR lab and adjunction room can reduce the level of exposure for the main surgeon and assistant surgeon. Turning on the cooling fan of the endoscope imager may result in a higher exposure level for the assistant surgeon. Surgical nurses outside of the surgical microenvironment are exposed to similar contaminant concentration levels in the breathing zone as in the exhaust. However, the ventilation efficiency is not constant near the surgical patient or in the rest of the room and will vary with a change in pressure difference. This may suggest that the air may not be fully mixed in the surgical microenvironment.

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INTRODUCTION: This case is shared to reiterate and confirm the principles of ensuring the safety of the surgical team caring for COVID-19-confirmed patients, thus, preventing the spread of infection within the hospital. CASE PRESENTATION: A 54-year-old male, COVID-19-confirmed patient complaining of abdominal pain since two days prior was transferred to our hospital. Perforated appendicitis with a periappendiceal abscess was diagnosed by computed tomography. Laparoscopic appendectomy was performed in a negative-pressure operating room. The surgical team wore enhanced personal protective equipment. Electrocautery was not used during surgery and no other special instruments were applied to reduce aerosol generation. No special instruments or filters were used for the removal of intra-abdominal gas. The operation was completed successfully and no immediate surgical complications occurred. The patient advanced to a normal diet on the 4th postoperative day. The patient was treated with antibiotics for bacteremia and antiviral therapy for underlying pneumonia in the setting of COVID-19 with most symptoms dissipating by the 7th postoperative day. The patient was discharged on the 30th postoperative day without any complications. DISCUSSION: A well-designed manual, a well-trained surgical team, and a negative-pressure operating room are essential for safe laparoscopic appendectomies in COVID-19 patients. CONCLUSION: When surgery is performed in a negative-pressure operating room by a well-trained surgical team, a laparoscopic appendectomy can be successfully performed under the principles of obtaining optimum clinical outcomes while faithfully ensuring the safety of healthcare providers and the hospital environment.

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This paper summarized the operation cooperation and management of the first case of bilateral lung transplantation assisted with double extracorporeal membrane oxygenation (ECMO) for the recipient with novel coronavirus pneumonia (COVID-19) in the world. The bilateral lung transplantation assisted by double ECMO had been accomplished successfully on a recipient with COVID-19, who was supported by ventilator and ECMO, with other organs function basically normal. The operation took 405 min and went smoothly. The cooperation and management guidelines of the operation room included the following: setting up of COVID-19 emergency operation group quickly; listing and preparing of the detailed operation supplies; transferring of the whole system of lung transplantation operating room in Wuxi People's Hospital to the Wuxi No.5 People's Hospital (isolation hospital); reconstruction of a negative pressure operating room for lung transplantation; formulating and strictly implementing the guidelines and management process for the operation of patient with COVID-19.