Bio

Clinical Focus

  • Pediatric Surgery
  • Chest Wall Deformities
  • Minimal Access Surgery
  • Neonatal Surgery
  • Trauma
  • Adolescent Weight Management and Bariatric Surgery
  • Congenital Diaphragmatic Hernia
  • Pediatric Biliary Disease
  • Anorectal Malformations

Academic Appointments

Administrative Appointments

  • Program Director, Chest Wall Program, Stanford Children's Health (2016 - Present)
  • Trauma Medical Director, Lucile Packard Children's Hospital at Stanford (2016 - Present)
  • Course Director, Division of Pediatric Surgery Continuing Medical Education (2015 - Present)
  • Surgical Representative, LPCH Operating Room Local Improvement Team (LIT) (2013 - Present)
  • Resident Representative, Stanford Graduate Medical Education Committee (2008 - 2010)

Honors & Awards

  • Asian Pacific American Heritage Month Honoree, NBC, Asian Americans for Community Involvement (AACI) (2019)
  • Best Abstract Award, IRCAD France - Research Institute against Digestive Cancer (2019)
  • Coolest Tricks Award, International Pediatric Endosurgery Group (IPEG) (2019)
  • Hepatitis Testing Innovation Contest Commendation Award, European Association for the Study of the Liver(EASL)/World Health Organization (2016)
  • Lloyd Nyhus Travel Scholar, US International Surgical Society (2015)
  • Hilary Sanfey Outstanding Resident (awarded to most outstanding female surgery resident in the US), Association of Women Surgeons (2012)
  • Best Poster Presentation, SNMA Annual Medical Education Conference (2011)
  • Samuel L. Kountz Humanitarian Award, Stanford University (2009)
  • Residents in Radiology Executive Council Award (Outstanding Poster), American Roentgen Ray Society (2005)
  • Research Fellowship, University of California Dean's Research Grant (2003)
  • Research Scholarship, Child Neurology Foundation (2003)
  • Aces for Campus Excellence, Doublemint (2002)
  • Phi Beta Kappa, Phi Beta Kappa Society (2002)
  • Research fellowship, Howard Hughes Medical Institute Summer Research Fellowship (2001)

Boards, Advisory Committees, Professional Organizations

  • Member, Pediatric Trauma Society (2016 - Present)
  • Fellow, American Academy of Pediatrics (2014 - Present)
  • Member, American Pediatric Surgical Association (2014 - Present)
  • Member, Association of Women Surgeons (2013 - Present)
  • Board of Directors, National Resident Matching Program (NRMP) (2010 - 2012)
  • Invited Consultant, World Health Organization (WHO), Western Pacific Region - Laos (2010 - 2010)
  • Advisory Committee, Immunization Action Coalition ? Birth Dose Project (2009 - Present)
  • Advisory Committee, California Viral Hepatitis Clinical Task Force (2009 - Present)
  • Taskforce Member, National Hepatitis B Task Force (2009 - Present)
  • Advisory Committee, Viral Hepatitis and Liver Cancer Prevention Control Act 2009 (US Congressional Bill# H.R. 3974) (2009 - 2009)
  • Fellow, American College of Surgeons (2006 - Present)

Professional Education

  • Fellowship: Stanford University Pediatric Surgery (2015) CA
  • Residency: Stanford University General Surgery Residency (2013) CA
  • Board Certification: American Board of Surgery, Pediatric Surgery (2016)
  • Board Certification: American Board of Surgery, General Surgery (2013)
  • Medical Education: University of California San Francisco (2006) CA

Community and International Work

  • Jade Ribbon Campaign, China, Vietnam, Laos, Korea, Philippines

    Topic

    Hepatitis B and liver cancer control

    Partnering Organization(s)

    Asian Liver Center

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Hep B Moms, China, Vietnam, Laos, Korea, Philippines

    Topic

    Reducing perinatal hepatitis B transmission

    Partnering Organization(s)

    HepBMoms.org

    Populations Served

    Women and children

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Contact

    • Tel: (650) 723-6439
  • Hadley Monin Administrative Assistant
    • Tel: 650-723-6439
  • Pediatric General Surgery 300 Pasteur Dr Rm M116 Alway Bldg MC 5733 Stanford, CA 94305
    • Tel: (650) 723-6439
    Fax: (650) 725-5577

Research & Scholarship

Current Research and Scholarly Interests

Dr. Chao's research focuses on preventing surgical diseases minimizing the impact of surgery. She works with the Asian Liver Center towards the global eradication of hepatitis B, the leading cause of liver cancer and liver disease globally. Dr. Chao helped launch the Jade Ribbon Campaign in 2001 to improve public and physician awareness about hepatitis B. Her work has been supported by the US Centers for Disease Control and the American Cancer Society. The Asian Liver Center also works in collaboration with the World Health Organization to improve screening and immunization strategies in Asia. For more information, visit: http://liver.stanford.edu AND http://hepbmoms.org

Dr. Chao also serves as the Trauma Medical Director for Stanford Children's Health. Her research and interests include preventing childhood injury, the leading cause of death among children.

Dr. Chao is the Director of the Stanford Chest Wall Program. She is interested in studying new ways to treat and image patients with pectus excavatum and pectus carinatum.

Dr. Chao is also working with pediatric anesthesiologists to find ways to minimize anxiety and discomfort associated with surgery. This includes the use of virtual reality to decrease periprocedural anxiety.

Other research interests: pediatric surgery, neonatal surgery, congenital diaphragmatic hernia outcomes, pediatric obesity, minimal access surgery

Clinical Trials

  • Longitudinal Virtual Reality Use in Pediatric Surgical Procedures Recruiting

    This study aims to investigate the use of virtual reality guided mindfulness meditation to reduce the pre and post-operative anxiety and pain of pediatric surgical patients.

    View full details

Projects

  • Chronic Hepatitis B and Liver Cancer control, Asian Liver Center, Stanford University

    Location

    International

  • Chest Wall Deformities: 3D imaging

    Location

    Stanford, CA

  • Pediatric Trauma Outcomes

    Location

    Stanford, CA

  • Congenital Diaphragmatic Hernia - Predictors of Surgical Outcomes

    Location

    Stanford, CA

  • Pediatric Per Oral Endoscopic Myotomy, Lucile Packard Children's Hospital

    Location

    Stanford, CA

  • Evaluation of laparoscopic assisted TAP blocks

    Location

    Stanford, CA

Teaching

2020-21 Courses

Stanford Advisees

Publications

All Publications

  • Correction to: Delayed appearance of mature ganglia in an infant with an atypical presentation of total colonic and small bowel aganglionosis: a case report. BMC pediatrics Salimi Jazi, F., Chandler, J. M., Thorson, C. M., Sinclair, T. J., Hazard, F. K., Kerner, J. A., Dutta, S., Dunn, J. C., Chao, S. D. 2019; 19 (1): 172

    Abstract

    Following publication of the original article [1], the authors reported error on the images/figures used which also resulted in un-sequential order. The updated figures and captions are provided below.

    View details for DOI 10.1186/s12887-019-1507-6

    View details for PubMedID 31138158

  • Delayed appearance of mature ganglia in an infant with an atypical presentation of total colonic and small bowel aganglionosis: a case report BMC PEDIATRICS Jazi, F., Chandler, J. M., Thorson, C. M., Sinclair, T. J., Hazard, F. K., Kerner, J. A., Dutta, S., Dunn, J. Y., Chao, S. D. 2019; 19

    View details for DOI 10.1186/s12887-019-1456-0

    View details for Web of Science ID 000463762700001

  • Delayed appearance of mature ganglia in an infant with an atypical presentation of total colonic and small bowel aganglionosis: a case report. BMC pediatrics Salimi Jazi, F., Chandler, J. M., Thorson, C. M., Sinclair, T. J., Hazard, F. K., Kerner, J. A., Dutta, S., Dunn, J. C., Chao, S. D. 2019; 19 (1): 93

    Abstract

    BACKGROUND: Total colonic and small bowel aganglionosis (TCSA) occurs in less than 1% of all Hirschsprung's disease patients. Currently, the mainstay of treatment is surgery. However, in patients with TCSA, functional outcomes are often poor. A characteristic transition zone in TCSA can be difficult to identify which may complicate surgery and may often require multiple operations.CASE PRESENTATION: We present the case of a male infant who was diagnosed with biopsy-proven total colonic aganglionosis with extensive small bowel involvement as a neonate. The patient was diverted at one month of age based on leveling biopsies at 10cm from the Ligament of Treitz. At 7months of age, during stoma revision for a prolapsed stoma, intra-operative peristalsis was observed in nearly the entire length of the previously aganglionic bowel, and subsequent biopsies demonstrated the appearance of mature ganglion cells in a previously aganglionic segment.CONCLUSIONS: TCSA remains a major challenge for pediatric surgeons. Our case introduces new controversy to our understanding of aganglionosis. Our observations warrant further research into the possibility of post-natal ganglion maturation and encourage surgeons to consider a more conservative surgical approach.

    View details for PubMedID 30953480

  • Firearm Legislation Stringency and Firearm-Related Fatalities among Children in the United States. Journal of the American College of Surgeons Madhavan, S., Taylor, J. S., Chandler, J. M., Staudenmayer, K. L., Chao, S. D. 2019

    Abstract

    BACKGROUND: Firearm-related injuries are the second leading cause of pediatric death in the U.S. We sought to evaluate the effectiveness of both state child access prevention (CAP) laws and gun regulations on pediatric firearm mortality. We hypothesized that states with more stringent firearm legislation had lower pediatric firearm mortality.STUDY DESIGN: We used 2014-2015 firearm mortality data from the Web-Based Injury Statistics Query and Reporting System, 2014 Brady scores (used to quantify stringency of state gun regulations) and CAP laws. State-level covariates were obtained from government sources including the Bureau of Labor Statistics and the Department of Education. Spearman rank correlations and linear regression were used to determine the relationship between overall pediatric firearm mortality and gun regulations. We also examined the relationship between gun regulations and firearm related homicides and suicides.RESULTS: Annually, there were approximately 2,715 pediatric firearm fatalities among children; 62.1% were homicides and 31.4% suicides. There was a moderate negative correlation between states' firearm legislation stringency and overall pediatric firearm mortality (rho=-0.66, p<0.001), and between CAP laws and firearm suicide rates (rho=-0.56, p<0.001). After controlling for poverty, unemployment, substance abuse, and the number of registered firearms, the association between firearm legislation stringency and overall pediatric firearm mortality remained significant (p=0.04). The association between CAP laws and firearm suicide rate remained significant after controlling for socioeconomic factors, registered firearms, and other firearm legislation (p=0.04).CONCLUSIONS: Strict gun legislation and CAP laws are associated with fewer pediatric firearm fatalities and firearm suicides, respectively, though no such association was identified with pediatric firearm homicides. While more studies are needed to determine causality, state-level legislation could play an important role in reducing pediatric firearm-related deaths.

    View details for PubMedID 30928667

  • Letter to the Editor: Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life WORLD JOURNAL OF SURGERY Darling, C., Chao, S., Ramamurthi, R., Tsui, B. 2019; 43 (3): 963?64

    View details for DOI 10.1007/s00268-018-4704-9

    View details for Web of Science ID 000457455400036

  • 3D Optical Imaging for Pectus Excavatum Assessment. The Annals of thoracic surgery Taylor, J. S., Madhavan, S., Szafer, D., Pei, A., Koppolu, R., Barnaby, K., Wall, J. K., Chao, S. D. 2019

    Abstract

    Corrective surgery for pectus excavatum often relies on the Haller index (HI), derived from chest radiographs or computed tomography; however, this exposes children to potentially unnecessary radiation. Our aim was to develop a novel 3D optical imaging technique to accurately measure chest wall dimensions in a clinically relevant manner.Patients with pectus excavatum were imaged using a 3D structured light scanner. Patient characteristics, including height, weight, BMI, and radiographic HIs (rHI) were recorded. We defined the optical index (OI) as the ratio of the lateral to anterior-posterior measurements obtained from the 3D optical images, and compared those to patients' rHIs. Two-thirds of the patients' images were used to develop a predictive model of the rHI, utilizing their OI and biometric data in multilinear regression modeling. The predictive model was applied to the remaining images, and the predicted HIs (pHI) were compared to the rHIs.Forty-two patients (ages 5-35) with pectus excavatum underwent optical imaging; 31 had recent chest radiographs, with rHIs ranging from 2.00-7.20. The OIs derived from the images correlated closely with rHIs (R=0.850). Our predictive model, utilizing patients' OI, height, and weight was able to accurately estimate their rHIs with a median error of 8.11% (IQR 3.5-17.4%).3D optical imaging of patients with pectus excavatum is emerging as an alternative method to assess HIs without the use of ionizing radiation. Additional studies will focus on volumetric quantification of chest wall deformities, utilizing the 3D capabilities of this technology.

    View details for DOI 10.1016/j.athoracsur.2019.04.074

    View details for PubMedID 31201783

  • Impact of licensed federal firearm suppliers on firearm-related mortality Chao, S. D., Kastenberg, Z. J., Madhavan, S., Staudenmayer, K. LIPPINCOTT WILLIAMS & WILKINS. 2019: 123?27

    View details for DOI 10.1097/TA.0000000000002067

    View details for Web of Science ID 000454937100017

  • Management of hepatitis B infected pregnant women: a cross-sectional study of obstetricians. BMC pregnancy and childbirth Chao, S. D., Cheung, C. M., Chang, E. T., Pei, A., So, S. K. 2019; 19 (1): 275

    Abstract

    Our study aims to describe how obstetricians manage pregnant women infected with chronic hepatitis B in a region with a large high-risk population.We performed a cross-sectional study among practicing obstetricians in Santa Clara County, California. All obstetricians practicing in Santa Clara County were invited to participate in the study. Obstetricians were recruited in person or by mail to complete a voluntary, multiple choice survey on hepatitis B (HBV). Survey questions assessed basic HBV knowledge and obstetricians' self-reported clinical practices of the management of HBV-infected pregnant women. Pooled descriptive analyses were calculated for the cohort, as well as, correlation coefficients to evaluate the association between reported clinical practices and hepatitis B knowledge.Among 138 obstetricians who completed the survey, 94% reported routinely testing pregnant women for hepatitis B surface antigen (HBsAg) with each pregnancy. Only 60.9% routinely advised HBsAg-positive patients to seek specialist evaluation for antiviral treatment and monitoring and fewer than half (48.6%) routinely provided them with HBV information. While most respondents recognized the potential complications of chronic HBV (94.2%), only 21% were aware that chronic HBV carries a 25% risk of liver related death when left unmonitored and untreated, and only 25% were aware of the high prevalence of chronic HBV in the foreign-born Asian, Native Hawaiian and Pacific Islander population. Obstetricians aware of the high risk of perinatal HBV transmission were more likely to test pregnant women for HBV DNA or hepatitis B e-antigen in HBV-infected women (r?=?0.18, p?=?0.033). Obstetricians who demonstrated knowledge of the long-term consequences of untreated HBV infection were no more likely to refer HBV-infected women to specialists for care (r?=?0.02, p?=?0.831).Our study identified clear gaps in the practice patterns of obstetricians that can be readily addressed to enhance the care they provide to HBV-infected pregnant women.

    View details for DOI 10.1186/s12884-019-2421-5

    View details for PubMedID 31375078

  • Strict Firearm Legislation Is Associated with Lower Firearm-Related Fatalities among Children and Teens in the US Chao, S. D., Madhavan, S. ELSEVIER SCIENCE INC. 2018: E33?E34

    View details for DOI 10.1016/j.jamcollsurg.2018.08.087

    View details for Web of Science ID 000447772500074

  • Impact of Licensed Federal Firearm Suppliers on Firearm-Related Mortality. The journal of trauma and acute care surgery Chao, S. D., Kastenberg, Z. J., Madhavan, S., Staudenmayer, K. L. 2018

    Abstract

    BACKGROUND: Legal firearm sales occur largely through suppliers that have Federal Firearm Licensees (FFLs). Since FFL density might reflect ease-of-access to firearm purchases, we hypothesized that the number of FFL dealers would be associated with firearm-related deaths. We further hypothesized that licensee-type subsets would be associated with differential risks for gun-related deaths.METHODS: We used data from the National Center for Health Statistics National Vital Statistics System (2008-2014) and national data on Federal Firearms Licensees for 2014. Correlation analysis and linear regression analysis were performed to determine the relationship between different licensee types and firearm-related deaths. We controlled for population, number of statewide registered firearms, and the density of other types of FFLs.RESULTS: We identified a total of 65,297 FFLs. There was a moderate correlation (R = 0.53, rho = 0.48) between total FFL density and firearm-related death rates. Further analysis by type of firearm-related death showed a strong correlation (R = 0.81, rho = 0.76) between total FFL density and firearm-related suicide rates. No correlation was found between total FFL density and firearm-related homicide rate. Among individual FFL types, FFL02 (firearm dealing pawnshop) density was the only FFL-type found to be correlated with firearm-related death rates. We found a strong correlation between FFL02 density and overall firearm-related death rate (R = 0.69, rho = 0.78) and firearm-related suicide rate (R = 0.72, rho = 0.78). Linear regression analysis showed that even while controlling for number of registered firearms and population, the number of firearm-dealing pawnshops remained significantly associated with overall firearm-related deaths and firearm-related suicides.CONCLUSION: Access to legally-distributed firearms is associated with firearm-related death rates, particularly firearm-related suicides. Specifically, firearm-dealing pawnshops were associated with suicide-related deaths. These findings suggest that deeper exploration of legal firearm access and firearm-related injuries would benefit discussion of preventative measures.LEVEL OF EVIDENCE: IV TYPE OF STUDY: Prognostic and Epidemiological.

    View details for PubMedID 30212424

  • A Simplified Method for Three-Dimensional Optical Imaging and Measurement of Patients with Chest Wall Deformities. Journal of laparoendoscopic & advanced surgical techniques. Part A Szafer, D., Taylor, J. S., Pei, A., de Ruijter, V., Hosseini, H., Chao, S., Wall, J. 2018

    Abstract

    BACKGROUND: Pectus excavatum and carinatum are two of the most commonly observed chest wall deformities in pediatrics. The standard diagnostic evaluation for these conditions includes either chest radiograph (CXR) or computed tomography (CT). Our research aims to develop a novel and reliable way of quantifying chest wall deformities in the clinic setting without radiation exposure.METHODS: Using a handheld structured light scanner, we created three-dimensional (3D) models of patients with chest wall deformities through an IRB-approved protocol. Raters from a variety of backgrounds were then asked to take measurements based on the 3D model utilizing commercially available 3D graphical software. The standard deviation of the measurements and intraclass correlation coefficient (ICC) were then calculated to quantify inter-rater reliability.RESULTS: Sixty patients with pectus excavatum (Haller index range 2.0-6.38) and pectus carinatum were enrolled and imaged in our outpatient clinic using a structured light scanner. Five patients were used to verify interuser reliability. The standard deviation of all the measurements was 2.2mm. The ICC for absolute agreement was 0.99139, with 1.0 being perfect correlation.CONCLUSION: Structured light scanners provide an alternative approach to quantifying chest wall deformities in pediatric patients without radiation exposure. Our method is highly reliable, even among users with minimal image processing or 3D modeling experience. Our protocol can potentially be used to track treatment progress in children with chest wall deformities.

    View details for PubMedID 30207836

  • A Simplified Method for Three-Dimensional Optical Imaging and Measurement of Patients with Chest Wall Deformities Szafer, D., Taylor, J. S., Pei, A., de Ruijter, V., Hosseini, H., Chao, S., Wall, J. MARY ANN LIEBERT, INC. 2019: 267?71

    View details for DOI 10.1089/lap.2018.0191

    View details for Web of Science ID 000444377300001

  • Initial experience with peroral endoscopic myotomy for treatment of achalasia in children JOURNAL OF PEDIATRIC SURGERY Kethman, W. C., Thorson, C. M., Sinclair, T. J., Berquist, W. E., Chao, S. D., Wall, J. K. 2018; 53 (8): 1532?36

    View details for DOI 10.1016/j.jpedsurg.2017.07.023

    View details for Web of Science ID 000439577000014

  • Letter to the Editor: Early Consequences of Pectus Excavatum Surgery on Self-Esteem and General Quality of Life. World journal of surgery Darling, C., Chao, S., Ramamurthi, R., Tsui, B. 2018

    View details for PubMedID 29882100

  • Pleomorphic myxoid liposarcoma in an adolescent with Li-Fraumeni syndrome. Pediatric surgery international Sinclair, T. J., Thorson, C. M., Alvarez, E., Tan, S., Spunt, S. L., Chao, S. D. 2017

    Abstract

    We present the case of a 15-year-old female with a right perineal mass that was found to be pleomorphic myxoid liposarcoma, a recently recognized, rare subtype of liposarcoma. The patient had a strong family history of malignancy and genetic screening revealed a pathogenic TP53 mutation consistent with Li-Fraumeni syndrome.

    View details for DOI 10.1007/s00383-017-4063-x

    View details for PubMedID 28160093

  • A multidisciplinary approach to laparoscopic sleeve gastrectomy among multiethnic adolescents in the United States. Journal of pediatric surgery Jaramillo, J. D., Snyder, E., Farrales, S., Stevens, M., Wall, J. K., Chao, S., Morton, J., Pratt, J. S., Hammer, L., Shepard, W. E., Bruzoni, M. 2017

    Abstract

    Childhood obesity has become a serious public health problem in our country with a prevalence that is disproportionately higher among minority groups. Laparoscopic sleeve gastrectomy (LSG) is gaining attention as a safe bariatric alternative for severely obese adolescents.A retrospective study on morbidly obese adolescents that underwent LSG at our institution from 2009 to 2017. Primary outcomes were weight loss as measured by change in BMI and percent excess weight loss (%EWL) at 1 year after surgery, resolution of comorbidities and occurrence of complications.Thirty-eight patients, of whom 71% were female and 74% were ethnic minorities, underwent LSG between 2009 and 2016. Mean age was 16.8years, mean weight was 132.0kg and mean BMI was 46.7. There were no surgical complications. Mean %EWL was 19.4%, 27.9%, 37.4%, 44.9%, and 47.7% at 1.5, 3, 6, 9, and 12month follow up visits, respectively. Comorbidity resolution rates were 100% for hypertension and nonalcoholic fatty liver disease, 91% for diabetes, 44% for prediabetes, 82% for dyslipidemia and 89% for OSA.LSG is an effective and safe method of treatment of morbid obesity in adolescents as it can significantly decrease excess body weight and resolve comorbid conditions. Further studies are needed to investigate the long-term effects of LSG in adolescents.Descriptive case series with prospective database.IV.

    View details for PubMedID 28697852

  • Initial experience with peroral endoscopic myotomy for treatment of achalasia in children. Journal of pediatric surgery Kethman, W. C., Thorson, C. M., Sinclair, T. J., Berquist, W. E., Chao, S. D., Wall, J. K. 2017

    Abstract

    Achalasia is a primary esophageal motility disorder characterized by aperistalsis of the esophagus and failed relaxation of the lower esophageal sphincter that presents rarely in childhood. The peroral endoscopic myotomy (POEM) procedure is an emerging treatment for achalasia in adults that has recently been introduced into pediatric surgical practice.This is a prospective case series of all children referred to Stanford University Lucile Packard Children's Hospital with manometry-confirmed achalasia who underwent a POEM procedure from 2014 to 2016.We enrolled 10 subjects ranging in age from 7 to 17years (M=13.4). The mean pre- and 1-month post-procedure Eckardt scores were 7 (SD=2.5) and 2.4 (SD=2) (p<0.001), respectively. The median procedure time for the entire cohort was 142min (range 60-259min) with ongoing improvement with increased experience (R2=0.6, p=0.008). There were no major adverse events.The POEM procedure can be successfully completed in children for the treatment of achalasia with demonstrated short-term post-operative improvement in symptoms. The adoption of advanced endoscopic techniques by pediatric surgeons may enable development of unique intraluminal approaches to congenital anomalies and other childhood diseases.Treatment Study - Level IV.

    View details for PubMedID 28827050

  • A Multidisciplinary Approach to Laparoscopic Sleeve Gastrectomy Among Multiethnic Adolescents in the United States Jaramillo, J. D., Snyder, E., Farrales, S., Wall, J. K., Chao, S., Hammer, L. D., Albanese, C., Morton, J. M., Bruzoni, M. ELSEVIER SCIENCE INC. 2016: E153

    View details for DOI 10.1016/j.jamcollsurg.2016.08.390

    View details for Web of Science ID 000395825100335

  • Salvage of a failed open gastrocutaneous fistula repair with an endoscopic over-the-scope clip JOURNAL OF PEDIATRIC SURGERY CASE REPORTS Jaramillo, J., Hyun, J., Abrajano, C., Koppolu, R., Chao, S., Hartman, G., Wall, J. 2016; 8: 40?41

    View details for DOI 10.1016/j.epsc.2016.03.015

    View details for Web of Science ID 000376096600013

  • Endoscopic Division of Duodenal Web Causing Near Obstruction in 2-Year-Old with Trisomy 21 JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Wood, L. S., Kastenberg, Z., Sinclair, T., Chao, S., Wall, J. K. 2016; 26 (5): 413-417

    Abstract

    Surgical intervention for duodenal atresia most commonly entails duodenoduodenostomy in the neonatal period. Occasionally, type I duodenal atresia with incomplete obstruction may go undiagnosed until later in life. Endoscopic approach to dividing intestinal webs has been reported as successful in patients as young as 7 days of age, and can be a useful modality particularly in patients with comorbidities who may not tolerate open or laparoscopic surgery.A 2-year-old female with a history of trisomy 21 and tetralogy of Fallot underwent laparoscopic and endoscopic exploration of intestinal obstruction as seen on upper gastrointestinal series for symptoms of recurrent emesis and weight loss. After laparoscopy confirmed a duodenal web as the cause of intestinal obstruction, endoscopic division of the membrane was carried out with a triangle tip electrocautery knife and 15?mm radially dilating balloon.The patient tolerated the procedure well, and also tolerated full age-appropriate diet by time of discharge on postoperative day 2. She remains asymptomatic as of 6 months postoperatively.This report describes a successful endoscopic approach for definitive treatment of a duodenal web in a 2-year-old girl with trisomy 21, and laparoscopy confirmed no intraabdominal obstructive process or complication from endoscopy. Endoscopy enables minimal recovery time and suggests an improved method of duodenal web division over pure surgical intervention.

    View details for DOI 10.1089/lap.2015.0462

    View details for Web of Science ID 000376469600014

    View details for PubMedID 26913816

  • Multimodality Renal Failure in a Patient with OEIS Complex. AJP reports Santoro, J. D., Chao, S., Hsieh, M. H., Lee, H. C. 2015; 5 (2): e161-4

    Abstract

    Omphalocele-exstrophy of the bladder-imperforate anus-spinal defect (OEIS) complex is a rare constellation of clinical abnormalities with wide phenotypic presentation. We describe a case of a preterm neonate with OEIS complex with acute renal failure, and the challenges in diagnosis and management of this patient as renal failure can be a multifactorial process when encountered with this rare complex.

    View details for DOI 10.1055/s-0035-1554799

    View details for PubMedID 26495176

    View details for PubMedCentralID PMC4603852

  • Medical training fails to prepare providers to care for patients with chronic hepatitis B infection. World journal of gastroenterology Chao, S. D., Wang, B., Chang, E. T., Ma, L., So, S. K. 2015; 21 (22): 6914-6923

    Abstract

    To investigate physicians' knowledge including chronic hepatitis B (CHB) diagnosis, screening, and management in various stages of their training.A voluntary 20-question survey was administered in Santa Clara County, CA where Asian and Pacific Islanders (API) account for a third of the population. Among the 219 physician participants, there were 63 interns, 60 second-year residents, 26 chief residents and 70 attending physicians. The survey asked questions regarding respondents' demographics, general hepatitis B virus knowledge questions (i.e., transmission, prevalence, diagnostic testing, prevention, and treatment options), as well as, self-reported practice behavior and confidence in knowledge.Knowledge about screening and managing patients with CHB was poor: only 24% identified the correct tests to screen for CHB, 13% knew the next steps for patients testing positive for CHB, 18% knew the high prevalence rate among API, and 31% knew how to screen for liver cancer. Wald chi-square analysis determined the effect of training level on knowledge; in all cases except for knowledge of liver cancer screening (P = 0.0032), knowledge did not significantly increase with length in residency training or completion of residency.Even in a high-risk region, both medical school and residency training have not adequately prepared physicians in the screening and management of CHB.

    View details for DOI 10.3748/wjg.v21.i22.6914

    View details for PubMedID 26078568

    View details for PubMedCentralID PMC4462732

  • Initial Results of Endoscopic Gastrocutaneous Fistula Closure in Children Using an Over-the-Scope Clip. Journal of laparoendoscopic & advanced surgical techniques. Part A Wright, R., Abrajano, C., Koppolu, R., Stevens, M., Nyznyk, S., Chao, S., Bruzoni, M., Wall, J. 2015; 25 (1): 69-72

    Abstract

    Gastrocutaneous fistula (GCF) occurs commonly in pediatric patients after removal of long-term gastrostomy tubes. Although open repair is generally successful, endoscopic approaches may offer benefits in terms of incisional complications, postoperative pain, and procedure time. In addition, endoscopic approaches may offer particular benefit in patients with varied degrees of skin irritation or erosion surrounding a GCF, making surgical repair difficult, or patients with significant comorbidities, making minimal intervention and anesthesia time preferable. Over-the-scope (OSC) clips are a new technology that enables endoscopic closure of intestinal fistulas up to 2?cm in diameter. Six pediatric patients underwent endoscopic GCF closure using OSC clips under Institutional Review Board approval. The procedure was technically successful in 5 of 6 cases with an average operating time of 29 minutes. The technical failure required an open revision, whereas all other patients reported full healing of the GCF site at 1 month. All successful cases were performed as outpatients without postoperative narcotics. In addition, all patients reported high satisfaction with the procedure and cosmetic results. Endoscopic GCF closure using an OSC clip is technically feasible in the pediatric population. Based on limited cases with a 1-month follow-up, the functional and cosmetic results of technically successful cases are excellent. Endoscopic GCF closure is a potential alternative to standard surgical closure in patients with skin irritation or erosion and/or significant comorbidities.

    View details for DOI 10.1089/lap.2014.0379

    View details for PubMedID 25531644

  • Introduction of the Per-Oral Endoscopic Myotomy Technique to Pediatric Surgical Practice J Pediatr Surg Case Rep Chao, S. D., Russo, M., Wright, R., Rivas, H., Wall, J. K. 2014; 2 (6)
  • Introduction of the per-oral endoscopic myotomy technique to pediatric surgical practice Journal of Pediatric Surgery Case Reports Chao, S., Russo, M., Wright, R., Rivas, H., Wall, J. 2014

    View details for DOI 10.1016/j.epsc.2014.06.009

  • Intraoperative functional luminal imaging to assess esophagogastric junction distensibility during per-oral endoscopic myotomy in pediatric patients J Gastroint Dig Syst Wright, R., Chao, S. D., Wall, J. K. 2014; 4 (4)
  • Education and counseling of pregnant patients with chronic hepatitis B: perspectives from obstetricians and perinatal nurses in santa clara county, california. Asian Pacific journal of cancer prevention Yang, E. J., Cheung, C. M., So, S. K., Chang, E. T., Chao, S. D. 2013; 14 (3): 1707-1713

    Abstract

    Background: This study aimed to better understand the barriers to perinatal hepatitis B prevention and to identify the reasons for poor hepatitis B knowledge and delivery of education to hepatitis B surface-antigen- positive pregnant women among healthcare providers in Santa Clara County, California. Materials and Methods: Qualitative interviews were conducted with 16 obstetricians and 17 perinatal nurses in Santa Clara County, California, which has one of the largest populations in the United States at high risk for perinatal hepatitis B transmission. Results: Most providers displayed a lack of self-efficacy attributed to insufficient hepatitis B training and education. They felt discouraged from counseling and educating their patients because of a lack of resources and discouraging patient attitudes such as stigma and apathy. Providers called for institutional changes from the government, hospitals, and nonprofit organizations to improve care for patients with chronic hepatitis B. Conclusions: Early and continuing provider training, increased public awareness, and development of comprehensive resources and new programs may contribute to reducing the barriers for health care professionals to provide counseling and education to pregnant patients with chronic hepatitis B infection.

    View details for PubMedID 23679261

  • Low Levels of Knowledge and Preventive Practices Regarding Vertical Hepatitis B Transmission among Perinatal Nurses JOGNN-JOURNAL OF OBSTETRIC GYNECOLOGIC AND NEONATAL NURSING Chao, S. D., Cheung, C. M., Yang, E. J., So, S. K., Chang, E. T. 2012; 41 (4): 494-505

    Abstract

    To evaluate current levels of hepatitis-B-related knowledge and clinical practice among perinatal nurses.Cross-sectional study.Santa Clara County, California, home to one of the largest U.S. populations at risk of perinatal hepatitis B transmission.Perinatal nurses (N = 518) from eight birthing hospitals.In 2008-2010, nurses completed a baseline survey evaluating existing hepatitis-B-related knowledge and preventive clinical practices, participated in an educational seminar, received instructional materials about hepatitis B, and completed a follow-up knowledge survey.Eighty percent of perinatal nurses had provided health care to a pregnant woman with chronic hepatitis B, but only 51% routinely provided patients with educational information about hepatitis B. While 75% routinely informed patients about effective methods to prevent mother-to-child transmission, only a small minority (17-34%) educated infected women about standard recommendations for protecting themselves and household members. One fourth or fewer nurses correctly answered most questions about hepatitis B prevalence, risks, and symptoms. After the educational seminar, knowledge increased statistically significantly.Existing knowledge about hepatitis B is limited, and nationally recommended preventive clinical practices are commonly overlooked by perinatal nurses. This lack of knowledge and preventive care represents a noteworthy gap and an opportunity for targeted training and education to improve perinatal hepatitis B prevention and medical management of infected mothers.

    View details for DOI 10.1111/j.1552-6909.2012.01379.x

    View details for Web of Science ID 000306476300006

    View details for PubMedID 22697047

  • The Jade Ribbon Campaign: A systematic, evidence-based public awareness campaign to improve Asian and Pacific Islander health J Comm in Healthcare Chao, S. D., So, S. K. 2011; 4 (1)
  • The Jade Ribbon Campaign: A Model Program for Community Outreach and Education to Prevent Liver Cancer in Asian Americans JOURNAL OF IMMIGRANT AND MINORITY HEALTH Chao, S. D., Chang, E. T., Le, P. V., Prapong, W., Kiernan, M., So, S. K. 2009; 11 (4): 281-290

    Abstract

    The Jade Ribbon Campaign (JRC) is a culturally targeted, community-based outreach program to promote the prevention, early detection, and management of chronic hepatitis B virus (HBV) infection and liver cancer among Asian Americans. In 2001, 476 Chinese American adults from the San Francisco Bay Area attended an HBV screening clinic and educational seminar. The prevalence of chronic HBV infection was 13%; only 8% of participants showed serologic evidence of protective antibody from prior vaccination. Participants reported low preventive action before the clinic, but after one year, 67% of those with chronic HBV infection had consulted a physician for liver cancer screening, and 78% of all participants had encouraged family members to be tested for HBV. The increase in HBV awareness, screening, and physician follow-up suggests that culturally aligned interventions similar to the JRC may help reduce the disproportionate burden of disease to chronic HBV infection among Asian Americans.

    View details for DOI 10.1007/s10903-007-9094-2

    View details for Web of Science ID 000281505100005

    View details for PubMedID 17990118

  • Eliminating the Threat of Chronic Hepatitis B in the Asian and Pacific Islander Community: A Call to Action ASIAN PACIFIC JOURNAL OF CANCER PREVENTION Chao, S. D., Chang, E. T., So, S. K. 2009; 10 (3): 507-512

    Abstract

    Chronic hepatitis B in the Asian and Pacific Islander (API) population is among our nation's greatest ethnic and racial health disparities. Despite comprising 4.3% of the population, API make up a disproportionate half of the 1.2-2 million Americans living with chronic hepatitis B. As many as two-thirds of API are not aware of their infection because they have not been tested. This lack of knowledge prevents them from undergoing life-saving liver cancer screening and potential treatment. Likewise, those not protected are unaware that they should be vaccinated. Instead, there is a pervasive lack of awareness among API and healthcare providers. New concerted public health actions are needed to eliminate this major health disparity.

    View details for Web of Science ID 000270750100033

    View details for PubMedID 19640200

  • Short waitlist time does not adversely impact outcome following liver transplantation for hepatocellular carcinoma AMERICAN JOURNAL OF TRANSPLANTATION Chao, S. D., Roberts, J. P., Farr, M., Yao, F. Y. 2007; 7 (6): 1594-1600

    Abstract

    It has been suggested that patients with hepatocellular carcinoma (HCC) undergoing living donor liver transplantation (LDLT) have worse recurrence-free survival compared to deceased donor liver transplantation (CLT), leading to the hypothesis that short waitlist time or fast-tracking may include more aggressive tumors that would have been selected out by traditionally longer waitlist time. The primary aim of the present study was to evaluate the impact of waitlist time on HCC recurrence. The study cohort included 100 patients meeting T2 criteria by imaging before undergoing CLT (n = 90) or LDLT (n = 10). The 5-year recurrence-free probability was 89.9% for the entire cohort, and 91.9%, 90.5% and 86.6%, respectively, for waitlist time of 3 months or less, 3-6 months and > 6 months (p = 0.81). In the Cox proportional hazards model, waitlist time was also not a significant predictor of HCC recurrence. Tumor under-staging was observed in 20.5% of patients with waitlist time 3 months or less and 23.0% for waitlist time > 3 months (p = 0.81). In conclusion, our results failed to show an association between waitlist time and outcome after CLT or LDLT for HCC, and provided evidence disputing a significant role of waitlist time in the selection against HCC with unfavorable tumor biology.

    View details for DOI 10.1111/j.1600-6143.2007.01800.x

    View details for Web of Science ID 000246576700020

    View details for PubMedID 17430396

  • Anomalies of the corpus callosum: An MR analysis of the phenotypic spectrum of associated malformations AMERICAN JOURNAL OF ROENTGENOLOGY Hetts, S. W., Sherr, E. H., Chao, S., Gobuty, S., Barkovich, A. J. 2006; 187 (5): 1343-1348

    Abstract

    We sought to categorize the structural brain anomalies associated with abnormalities of the corpus callosum and anterior and hippocampal commissures in a large cohort.Brain MR images of adult and pediatric patients from our institution and from a national support organization (the ACC Network) were retrospectively evaluated for the type and severity of commissural anomalies and the presence and type of other structural abnormalities.Of 142 cases that were reviewed, 82 patients had agenesis of the corpus callosum (ACC), while 60 had hypogenesis of the corpus callosum (HCC). Of the overall cohort, almost all had reduced white matter volume outside the commissures, the majority had malformations of cortical development (most commonly heterotopia or abnormal sulcation), many had noncallosal midline anomalies (including abnormal anterior or hippocampal commissures and interhemispheric cysts and lipomas), and several patients had abnormalities of the cerebellum or brainstem. Sixty-six patients had Probst bundles, which were more common in patients with ACC than in those with HCC. Probst bundles were present in all four patients who had ACC or HCC but no other midline, cortical, or posterior fossa anomalies.Isolated commissural anomalies were rare in the populations of patients examined. Most cases of ACC and HCC were associated with complex telencephalic, diencephalic, or rhombencephalic malformations. Reduced cerebral hemispheric white matter volume and malformations of cortical development were seen in more than half of the patients, suggesting that many commissural anomalies are part of an overall cerebral dysgenesis. ACC and HCC appear to lie along a dysgenetic spectrum, as opposed to representing distinct disorders.

    View details for DOI 10.2214/AJR.05.0146

    View details for Web of Science ID 000241510800035

    View details for PubMedID 17056927

  • Single infusion of myeloid progenitors reduces death from Aspergillus fumigatus following chemotherapy-induced neutropenia BLOOD Bitmansour, A., Cao, T. M., Chao, S., Shashidhar, S., Brown, J. M. 2005; 105 (9): 3535-3537

    Abstract

    Hematopoietic progenitors committed to the myeloid lineage, the common myeloid and granulocyte-monocyte progenitors (CMP/GMP), have been shown to protect against opportunistic pathogens following myeloablative radiation; however, the efficacy of this approach has not been studied in the setting of chemotherapy-induced neutropenia. In this mouse model, the infusion of CMP/GMP on the day after 5-fluorouracil (5-FU) administration (D+1) resulted in a significant increase in the number of splenic neutrophils by D+8 when compared with 5-FU-only controls (P = .02), the majority of which were CMP/GMP-derived (54%). Moreover, 19% and 28% of neutrophils in the blood and bone marrow, respectively, were CMP/GMP-derived. Survival following intranasal challenge with the fungus Aspergillus fumigatus was significantly higher in CMP/GMP-infused mice than the controls (56% and 33% respectively; P = .019). Thus, a single infusion of CMP/GMP enhances tissue neutrophil content and increases survival against a lethal challenge with A fumigatus in the setting of chemotherapy-induced neutropenia.

    View details for DOI 10.1182/blood-2004-2004-07-2676

    View details for Web of Science ID 000228797400029

    View details for PubMedID 15576478

    View details for PubMedCentralID PMC1895020

  • Central nervous system aspergillosis in an immunocompetent patient: cure in a hospice setting with very high-dose itraconazole. The American journal of hospice & palliative care Palanisamy, A., Chao, S. D., Fouts, M., Kerr, D. 2005; 22 (2): 139-144

    Abstract

    Aspergillosis of the central nervous system (CNS) is a rare condition with exceedingly high mortality. This study describes the case of an immunocompetent 42-year-old man with a history of intravenous drug use and hepatitis C who developed multiple Aspergillus lesions in the cerebellum. Despite neurosurgery and antifungal therapy with amphotericin B, he had a protracted hospital course with multiple complications, eventually developing cognitive and motor impairment due to progressive cerebellar lesions. After transfer to hospice and palliative care service, oral itraconazole was escalated to 1600 mg/day with the hope of palliating headache, nausea, and cognitive impairment. Remarkably, the patient stabilized and improved over time. After 14 months, this unprecedented high-dose regimen was discontinued, and the patient was discharged home with only mild cerebellar motor impairment.

    View details for PubMedID 15853093

  • Lack of drug interaction conformity in commonly used drug compendia for selected at-risk dermatologic drugs AMERICAN JOURNAL OF CLINICAL DERMATOLOGY Chao, S. D., Maibach, H. I. 2005; 6 (2): 105-111

    Abstract

    Systemic treatments that have significant efficacy for dermatologic conditions can often cause severe adverse reactions when improperly combined with interacting drugs. We have noted discrepancies in the reporting of such drug-drug interactions among major drug compendia used in hospitals and physicians' offices.The aim of this study was to compare the consistency of drug-drug interaction listings among four of the most widely used English language drug compendia in the US.Drug monographs from Mosby's GenRx, USP DI, AHFS Drug Information, and the Physicians' Desk Reference were compared. The respective drug-drug interactions provided by the various compendia for four systemic agents -- dapsone, erythromycin, methotrexate and prednisone -- commonly prescribed for dermatologic purposes were compiled.We found considerable discrepancies among the compendia with respect to the number of drug interactions listed. Agreement among the compendia was especially poor when more than two sources were compared.There is a need for a drug compendium that reconciles drug-drug interaction reporting discrepancies under standardized criteria based on the scientific literature and clinical significance.

    View details for Web of Science ID 000228512000005

    View details for PubMedID 15799682

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