A new groin hernia classification with clinical relevance.

INTRODUCTION: Groin hernia is one of the most commonly managed surgical diseases around the world. The typical question asked by patients is "Does my hernia require urgent surgery?". The currently available classifications are insufficient to stratify patients into different groups. We propose a new classification that incorporates diverse clinical elements together with anatomical and other vital information, which allows us to stratify patients into different groups. METHOD: A task force was formed by the Hong Kong Hernia Society, working with international expert hernia surgeons. The framework of the classification system was formulated. Clinical elements that are important in groin disease stratification were identified. A comprehensive literature review was conducted using PubMed. Those which dictate the severity of the disease were selected and compiled to form the new proposed classification. Application of this classification model to a single hernia surgeon's registry in The Hong Kong Adventist Hospital Hernia Centre was done for initial evaluation. RESULT: This new classification incorporates important clinical characteristics forming a total of nine grades of differentiation, together with the anatomical details and special information. This comprehensive system allows the stratification of patients into different groups based on disease severity. It also enables more accurate data collection for future audits, comparisons of disease progression over time, and the effect of different management strategies for different-stage patients. CONCLUSION: This is the first classification system which incorporates essential clinical parameters, which allows the stratification of groin hernia into different stages. Further studies and validation should be performed to evaluate the usefulness and value of this classification in groin hernia management.

Dynamics of childhood obesity in Hong Kong throughout the COVID-19 pandemic before and after the school closures: a 3-year longitudinal study.

OBJECTIVE: This study is to evaluate if there is any difference in the balance between incidence of and remission from overweight/obesity in Hong Kong school-age children before and during the COVID-19 pandemic over three years. METHODS: This is a retrospective longitudinal study that involved children aged 6-16 years from a database of the School Physical Fitness Award Scheme. RESULTS: 2765 students were longitudinally followed up for two years. The prevalence of childhood overweight/obesity was increased between the 2019 and 2021 academic years (P < 0.001). During the COVID-19 pandemic, the rate of obesity remission significantly reduced by 7.9 % (P = 0.003), at a background of a plateau of obesity among children and adolescents. CONCLUSIONS: Our study provides evidence on the impact of school closure and home confinement as a standard infection control measure for the prevention of COVID-19, which are likely to break the balance between incidence of and remission from childhood obesity.

Cataract risk of neuro-interventional procedures: a nationwide population-based matched-cohort study.

AIM: To demonstrate the risk of cataract associated with radiation exposure from neuro-interventional procedures. MATERIALS AND METHODS: This was a nationwide population-based, matched-cohort study. The exposed group (group E) comprised patients diagnosed with an aneurysm, cerebrovascular system anomaly, or subarachnoid haemorrhage who underwent a neuro-interventional procedure, such as brain digital subtraction angiography or endovascular embolisation. The comparison group (group C) included subjects who were never exposed to radiation from neuro-interventional procedures and were propensity score-matched by the date of enrolment, age, sex, and associated comorbidities. Multiple Cox proportional hazard regression analysis was used to estimate the hazard ratio (HR) of cataract risk due to radiation exposure while adjusting for potential confounding factors. RESULTS: There were 838 patients and 3,352 matched subjects in groups E and C, respectively. The incidence of cataracts was significantly greater among subjects in group E (adjusted HR [aHR] = 1.88; 95% confidence interval [CI] = 1.08-3.26), especially those aged >40 years (aHR = 2.14; 95% CI = 1.16-3.94). The number of computed tomography examinations was positively correlated, but not statistically significant, with an increased risk of cataract occurrence. CONCLUSIONS: Neuro-interventional procedures might be significantly associated with an increased risk of cataract occurrence.

A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique.

BACKGROUND: Tissue-selecting technique (TST) is a novel stapled hemorrhoidectomy technique which targets the hemorrhoids, leaving uninvolved mucosal bridges intact and avoiding circumferential circular stapling. The aim of this study was to compare the short-term outcomes of TST and transanal hemorrhoidal dearterialization (THD). METHODS: Patients presenting with symptomatic hemorrhoids were recruited. Patients were randomized into two groups: (1) TST and (2) THD. Patient demographics, perioperative data, postoperative pain scores, recurrence and patient satisfaction scores were evaluated. Patients with acute thrombosed hemorrhoids, external hemorrhoids only, or other concomitant anal diseases were excluded. RESULTS: From January 2013 to December 2015, 80 patients were included in the study, 40 in each group. There were no significant differences between groups as regards demographic data, perioperative data and postoperative pain scores. The median symptom scores for bleeding and prolapse were significantly lower in the TST group at 1 year (bleeding 1 vs. 2, p = 0.001; prolapse 1 vs. 2, p = 0.025). There was significantly less recurrence requiring reintervention in the TST group (4/40 vs. 17/40, p = 0.001). Satisfaction was significantly greater after TST. The median satisfaction scores after TST and THD were 4 and 3 (on a scale of 1-4; 4 = excellent satisfaction) (p < 0.00001), respectively. CONCLUSIONS: Both THD and TST are safe, and they appear to have similar short-term outcomes; however, TST is associated with better improvement in symptoms, lower recurrence rates and greater patient satisfaction.

Psychiatric Morbidity in Chinese Adults with Type 1 Diabetes in Hong Kong.

OBJECTIVES: To determine the prevalence of psychiatric morbidity and identify the correlates, as well as to evaluate the effectiveness of the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire to screen for psychiatric morbidity in Chinese adults with type 1 diabetes. METHODS: Subjects were recruited from a local public diabetes specialist outpatient clinic from August 2013 to January 2014. Demographic and clinical factors were recorded. Psychiatric diagnosis was established using the Chinese-bilingual version of the Structured Clinical Interview for the DSM-IV Axis I disorders. Scores for the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire were compared with the psychiatric diagnosis. RESULTS: Of the 136 patients, the point prevalence of overall psychiatric, depressive, and anxiety disorders was 39.7%, 23.5%, and 25.7%, respectively. Family history of mental illness, smoking status, history of mental illness, presence of social problems, perceived absence of confidant, presence of neuropathy and hyperlipidaemia, as well as higher level of glycosylated haemoglobin were found to be the associated factors. CONCLUSION: Psychiatric disorders were common in Chinese adults with type 1 diabetes. Finding out associated factors and using the Hospital Anxiety and Depression Scale and the 12-item General Health Questionnaire as a screening tool helped to identify patients in a diabetes clinic with psychiatric disorders.

Effects of Gender Difference and Caffeine Supplementation on Anaerobic Muscle Performance.

The primary purpose of this study was to investigate the effects of gender difference and caffeine supplementation to maximal voluntary isometric contractions (MVIC) and submaximal voluntary isometric contractions (T(lim)). 10 male (age: 20.10 ± 2.18 years, BMI: 22.23±1.96 kg/m(2)) and 10 female (age: 19.90±0.99 years, BMI: 21.76±2.65 kg/m(2)) elite collegiate athletes were recruited. Subjects ingested caffeine (6 mg/kg) or a placebo in a randomized, double-blind, placebo-control, and counter-balanced fashion. MVIC and T(lim) were measured after supplementations. T(lim) result was calculated based on the time to exhaustion of isometric contraction with 50% MVIC. Fatigue index (FI%) referred to the MVIC tested 20 s after the cessation of T(lim) test, and was indexed by the percentage of MVIC decline. No significant interaction effect was found between the gender factor and the supplementation factor for all dependent variables. Compared to the placebo, caffeine supplementation significantly increased MVIC (5.9%) and T(lim) (15.5%) (p<0.05) whereas it had no significant effect on FI%. This study demonstrates that caffeine supplementation at a 6 mg/kg dosage facilitates performances in MVIC and T(lim). The ergogenic effect of caffeine on muscle power and muscle endurance does not show a gender bias.

P2 purinergic receptor activation of neuronal nitric oxide synthase and guanylyl cyclase in the dorsal facial area of the medulla increases blood flow in the common carotid arteries of cats.

In the dorsal facial area (DFA) of the medulla, an activation of either P2 purinergic receptor or nitric oxide synthase (NOS) results in the release of glutamate, leading to an increase in blood flow of the common carotid artery (CCA). It is not known whether activation of the P2 receptor by ATP may mediate activation of NOS/guanylyl cyclase to cause glutamate release and/or whether L-Arg (nitric oxide (NO) precursor) may also cause ATP release from any other neuron, to cause an increase in CCA flow. We demonstrated that microinjections of P2 receptor agonists (ATP, α,ß-methylene ATP) or NO precursor (L-arginine) into the DFA increased CCA blood flow. The P2-induced CCA blood flow increase was dose-dependently reduced by pretreatment with NG-nitro-arginine methyl ester (L-NAME, a non-specific NOS inhibitor), 7-nitroindazole (7-NI, a relatively selective neuronal NOS inhibitor) or methylene blue (MB, a guanylyl cyclase inhibitor) but not by that with D-NAME (an isomer of L-NAME) or N5-(1-iminoethyl)-L-ornithine (L-NIO, a potent endothelial NOS inhibitor). Involvement of glutamate release in these responses were substantiated by microdialysis studies, in which perfusions of ATP into the DFA increased the glutamate concentration in dialysates, but co-perfusion of ATP with L-NAME or 7-NI did not. Nevertheless, the arginine-induced CCA blood flow increase was abolished by combined pretreatment of L-NAME and MB, but not affected by pretreatment with a selective P2 receptor antagonist, pyridoxalphosphate-6-azophenyl-2',4'-disulphonic acid (PPADS). In conclusion, ATP activation of the P2 receptor in the DFA induced activation of neuronal NOS/guanylyl cyclase, which causes glutamate release leading to an increase in CCA blood flow. However, arginine activation of neuronal NOS/guanylyl cyclase, which also caused glutamate release and CCA blood flow increase, did not induce activation of P2 receptors. These findings provide important information for drug design and/or developing therapeutic strategies for the diseases associated with CCA blood flow that supplies intra- and extra-cranial tissues.

A comparative study of single incision versus conventional laparoscopic inguinal hernia repair.

BACKGROUND: Over the past years, safety and feasibility of conventional laparoscopic inguinal hernia repair was well established. However, conventional laparoscopic hernia repair (CL) usually requires three working ports ranging from 5 to 10 mm, and each increasing port is associated with possible increasing morbidity and pain related to ports. This has led to the development of single incision laparoscopic hernia repair (SIL) which can further reduce the port-related morbidities and improve cosmetic outcomes. The aim of the study was to evaluate the safety and feasibility of SIL using both transabdominal preperitoneal (TAPP) and totally preperitoneal (TEP) approaches and compare the patients' wound satisfaction between the two groups. METHODS: This is a retrospective review of prospectively collected data. We analyzed the results of patients who underwent either CL or SIL for inguinal hernia between January 2011 and July 2012 in Pamela Youde Nethersole Eastern Hospital. Patients' demographic details, type of hernia, operative time, mesh used, and post-operative complications were compared. A telephone survey was also conducted to evaluate patients' subjective wound satisfaction. RESULTS: In total, 32 SIL and 35 CL procedures were performed in this period. The two groups were matched for age, sex, type of hernia and ASA grading. The mean operative time was significantly shorter in the CL group (52.6 vs. 62.6 min, p = 0.02). All SIL procedures were completed successfully without conversion to CL or open repair and post-operative complications such as wound infection, seroma, recurrence and chronic pain were also comparable between the two groups. As for the telephone survey, SIL groups' wound is less obvious and less detectable by others as compared to CL, but on the whole both groups of patients are very satisfied with the wound outcomes. All the SIL groups would continue with their decision on SIL and 60 % of CL group would choose SIL if they had to go back in time. CONCLUSION: Our results have shown that in experienced hands, SIL is feasible and as safe as CL. Further randomized trials should be performed to evaluate the clinical application of single incision TEP and TAPP.

Cytomegalovirus disease after liver transplantation: a nationwide population-based study.

BACKGROUND: Cytomegalovirus (CMV) disease is a significant complication after liver transplantation. The estimated incidence varies among studies, which have been conducted in single regional centers and with small cohorts. In this study, we investigated the occurrence of CMV disease among liver transplant recipients in a national cohort in Taiwan. METHODS: This retrospective study used data from the Taiwan National Health Insurance Research Database. All liver transplant recipients in the catastrophic illness database from 2000 to 2009 were enrolled. Cases of CMV disease were identified from the admission database with the use of the ICD-9-CM code 078. RESULTS: The national cohort consisted of 1,721 liver transplant recipients (1,200 men and 521 women) with a mean age of 43.9 ± 8.9 years at the time of transplantation. The mean follow-up duration was 3.6 ± 2.7 years. The mortality rate was 14.9% at 1 year and 20.5% at 5 years. During the study period, 84 patients (4.9%) were diagnosed with CMV disease. The overall prevalence of CMV disease was 14.5 per 100 person-years. The cumulative incidences of post-transplantation CMV infection at 3 months, 6 months, 1 year, 2 years, 5 years, and 10 years were 1.2%, 2.7%, 3.8%, 4.2%, 4.8%, and 4.9%, respectively. The most common CMV-related diseases were colitis, hepatitis, and pneumonia. CONCLUSIONS: The risk of CMV disease was significantly elevated in the first 6 months after liver transplantation in the Taiwanese cohort.

Development and evaluation of a new multi-metal binding biosorbent.

A novel multi-metal binding biosorbent (MMBB) was developed by combining a group of three from the selective natural lignocellulosic agro-industrial wastes for effectively eliminating lead, cadmium, copper and zinc from aqueous solutions. Four MMBBs with different combinations (MMBB1: tea waste, corncob, sugarcane bagasse; MMBB2: tea waste, corncob and sawdust; MMBB3: tea waste, corncob and apple peel; MMBB4: tea waste, corncob and grape stalk) were evaluated. FTIR analysis for characterizing the MMBB2 explored that the MMBB2 contains more functional groups available for multi-metals binding. Comparing among the MMBBs as well as the single group biosorbents, MMBB2 was the best biosorbent with the maximum biosorption capacities of 41.48, 39.48, 94.00 and 27.23 mg/g for Cd(II), Cu(II), Pb(II) and Zn(II), respectively. After 5 times of desorption with CaCl2, CH3COOH and NaCl as eluent, the MMBB2 still remained excellent biosorptive capacity, so as it could be well regenerated for reuse and possible recovery of metals.

Typical lignocellulosic wastes and by-products for biosorption process in water and wastewater treatment: a critical review.

Biosorption on lignocellulosic wastes and by-products has been identified as a proper alternative to the existing technologies applied for toxic metal ion and dye removal from wastewater streams. This paper deals with utilization of typical low cost wastes and by-products produced in different food agricultural and agro-industries as biosorbent and reviews the current state of studies on a wide variety of cheap biosorbents in natural and modified forms. The efficiency of each biosorbent has been also discussed with respect to the operating conditions (e.g. temperature, hydraulic residence time, initial metal concentration, biosorbent particle size and its dosage), chemical modification on sorption capacity and preparation methods, as well as thermodynamics and kinetics.

Fifteen-year experience in managing obturator hernia: from open to laparoscopic approach.

PURPOSE: Obturator hernia is a rare disease and preoperative diagnosis is always difficult. There are increasing reports employing laparoscopic approach in the recent literature. Our aim was to review and compare the open and laparoscopic approach in repairing obturator hernia. METHODS: All patients with obturator hernia from 1997 to 2011 were recruited. Patient's demographics, presentation, operative details, morbidity, and mortality were retrospectively collected and reviewed. RESULTS: There were 36 patients during the 15-year period. All of them were elderly ladies (median 83). Nineteen underwent open surgery while 16 received laparoscopic surgery. Both age and ASA were comparable. The median operative time was 68 and 65 min for laparoscopic and open group, respectively (p = 0.690). The median hospital stay was significantly longer in the open group (19 vs 5 days, p = 0.007). There were less major complications (p = 0.004) and mortality (p = 0.049) in the laparoscopic group. Two recurrences were reported in the laparoscopic group, although statistically not significant (p = 0.202). CONCLUSIONS: Laparoscopic repair can achieve a shorter hospital stay and has lesser major complications and mortality in selected patients.

Feasibility of iron loaded 'okara' for biosorption of phosphorous in aqueous solutions.

This study investigated the feasibility of using soybean milk by-products (okara) as a sustainable biosorbent for phosphate removal in water and wastewater. The results show that raw okara could hardly decontaminate phosphate from aqueous solutions. Hence, in this work, okara was modified by being cationized using FeCl3 0.25 M (namely iron loaded okara, ILO) to enhance the phosphorus adsorption capacity. The phosphate sorption onto ILO was well achieved under the conditions of pH 3, initial phosphorous concentration of 25 mg/L, biosorbent dose of 20 mg/L and contact time of 7 h. Based on Langmuir model, the maximum adsorption capacity of phosphate by ILO was 4.785 mg/g. The effects of interfering anions were in the order of CO3(2-)>SO4(2-)>NO3(-). It was also observed that Fe(III) was detached during operation. This problem can hinder the sustainable usability of ILO. Thus, further research would be necessary for improving the modification method.

GSTP1 is a hub gene for gene-air pollution interactions on childhood asthma.

There is growing evidence that multiple genes and air pollutants are associated with asthma. By identifying the effect of air pollution on the general population, the effects of air pollution on childhood asthma can be better understood. We conducted the Taiwan Children Health Study (TCHS) to investigate the influence of gene-air pollution interactions on childhood asthma. Complete monitoring data for the ambient air pollutants were collected from Taiwan Environmental Protection Agency air monitoring stations. Our results show a significant two-way gene-air pollution interaction between glutathione S-transferase P (GSTP1) and PM10 on the risk of childhood asthma. Interactions between GSTP1 and different types of air pollutants have a higher information gain than other gene-air pollutant combinations. Our study suggests that interaction between GSTP1 and PM10 is the most influential gene-air pollution interaction model on childhood asthma. The different types of air pollution combined with the GSTP1 gene may alter the susceptibility to childhood asthma. It implies that GSTP1 is an important hub gene in the anti-oxidative pathway that buffers the harmful effects of air pollution.

Spontaneous autoimmune gastritis and hypochlorhydria are manifest in the ileitis-prone SAMP1/YitFcs mice.

SAMP1/YitFcs mice serve as a model of Crohn's disease, and we have used them to assess gastritis. Gastritis was compared in SAMP1/YitFcs, AKR, and C57BL/6 mice by histology, immunohistochemistry, and flow cytometry. Gastric acid secretion was measured in ligated stomachs, while anti-parietal cell antibodies were assayed by immunofluorescence and enzyme-linked immunosorbent spot assay. SAMP1/YitFcs mice display a corpus-dominant, chronic gastritis with multifocal aggregates of mononuclear cells consisting of T and B lymphocytes. Relatively few aggregates were observed elsewhere in the stomach. The infiltrates in the oxyntic mucosa were associated with the loss of parietal cell mass. AKR mice, the founder strain of the SAMP1/YitFcs, also have gastritis, although they do not develop ileitis. Genetic studies using SAMP1/YitFcs-C57BL/6 congenic mice showed that the genetic regions regulating ileitis had comparable effects on gastritis. The majority of the cells in the aggregates expressed the T cell marker CD3 or the B cell marker B220. Adoptive transfer of SAMP1/YitFcs CD4(+) T helper cells, with or without B cells, into immunodeficient recipients induced a pangastritis and duodenitis. SAMP1/YitFcs and AKR mice manifest hypochlorhydria and anti-parietal cell antibodies. These data suggest that common genetic factors controlling gastroenteric disease in SAMP1/YitFcs mice regulate distinct pathogenic mechanisms causing inflammation in separate sites within the digestive tract.

Glutathione S-transferase, incense burning and asthma in children.

Incense burning is a popular practice in many family homes and temples. However, little is known about the effects of indoor incense burning and genetic polymorphisms on asthma. This study evaluated the effects of indoor incense burning and glutathione S-transferase (GST) genetic polymorphisms on asthma and wheeze. In 2007, 3,764 seventh-grade schoolchildren (mean±sd age 12.42±0.65 yrs) were evaluated using a standard questionnaire for information about respiratory symptoms and environmental exposures. Multiple logistic regressions were performed to assess the association between GST polymorphisms and incense burning frequency on asthma and wheeze, after adjusting for potential confounders. The frequency of incense burning at home was associated with increased risk of current asthma (p=0.05), medication use (p=0.03) and exercise wheeze (p=0.001). GST1 (GSTT1) null genotypes were associated with current asthma (OR 1.43, 95% CI 1.00-2.04) and medication use (OR 1.46, 95% CI 1.01-2.22). GSTT1 showed a significant interactive effect with incense burning on current asthma, current wheeze and nocturnal wheeze. The frequency of incense burning was associated with increased risk of current asthma, medication use, lifetime wheeze, nocturnal wheeze and exercise wheeze in an exposure-response manner among children with GSTT1 null genotype (p<0.05). Incense burning is a risk factor for asthma and wheezing, especially in GSTT1 genetically susceptible children.

Dystocia in Formosan sambar deer (Cervus unicolor swinhoei) in semi-domesticated herds.

Over a nine-year period (2000 to 2008), 22 instances of dystocia and 50 normal fawnings in Formosan sambar deer (Cervus unicolor swinhoei) hinds from semi-domesticated herds were investigated. The majority of the hinds (17, 77.3 per cent) that suffered dystocia were categorised as having a body condition score (BCS) in the medium range (between 2.5 and 3.5 inclusive), indicating that there was no significant relationship between obesity (BCS >3.5) in hinds and the occurrence of dystocia. In addition, maternal body condition had no effect on the birthweight of the offspring. Among the 22 instances of dystocia, 16 of the fawns (72.7 per cent) did not survive; one of these deaths was anteparturient and the other 15 were parturient. Eighteen (81.8 per cent) of the cases of dystocia involved male fawns, and 15 (93.8 per cent) of the deaths were of male fawns (P=0.044). Nine (40.9 per cent) of the instances of dystocia resulted from maternal excitement, mainly attributable to disturbances caused by human beings. In 12 of the cases that resulted in the death of the fawn, the request for veterinary assistance had been delayed at least one day. There were six cases in which the fawns survived; these were the ones that had received assistance within six hours after the onset of parturition.

Splenic peliosis: an unusual entity.

This case of splenic peliosis, describes a rare condition when it presents in the spleen, and is better understood when it occurs in the liver. However, the ultrasound and CT features have a wide differential diagnosis including more common aetiologies, of either a vascular, infective or neoplastic nature, which should be considered. Peliosis is an important condition to be aware of because rupture of the blood-filled cysts on the spleen surface can lead to haemorrhagic peritonitis and ultimately be fatal.

Correlation between Klebsiella pneumoniae carrying pLVPK-derived loci and abscess formation.

Klebsiella pneumoniae-caused liver abscess (KLA) is an emerging infectious disease. However, factors other than K1-specific loci that contribute to the pathogenesis of this disease have not been identified. pLVPK is a 219,385-bp plasmid of K. pneumoniae CG43, an invasive K2 strain associated with KLA. We aimed in this study to evaluate the involvement of pLVPK in K. pneumoniae virulence and its clinical significance in abscess formation. A pLVPK-cured CG43 was isolated and its virulence was examined in a mouse model. The prevalence of pLVPK-derived loci terW, iutA, rmpA, silS, and repA was investigated in 207 clinical isolates by screening with specific primers. Loss of pLVPK abolished the ability of K. pneumoniae to disseminate into extraintestinal sites and, consequently, attenuated abscess formation in mice. Primary K. pneumoniae abscess isolates (n = 94) were more likely to be terW (+)-iutA (+)-rmpA (+)-silS (+) than those related to non-abscess infections (n = 113) (62% vs. 27%; p < 0.0001). Logistic regression analysis indicated that the presence of the terW-rmpA-iutA-silS loci was a significant risk factor (odds ratio, 4.12; 95% confidence interval, 2.02-8.4; p < 0.0001) for abscess formation. pLVPK is a determinant for K. pneumoniae virulence and infection with strains carrying the pLVPK-derived terW-rmpA-iutA-silS loci may predispose patients to abscess formation.

Epidemiology of Bartonella infection in rodents and shrews in Taiwan.

During the period of August 2002 and November 2004, an epidemiological investigation for Bartonella infection was conducted in small mammals in Taiwan. Using whole blood culture on chocolate agar plates, Bartonella species were successfully isolated from 41.3% of the 310 animals tested. The isolation rate of Bartonella species varied among different animal species, including 52.7% of the 169 Rattus norvegicus, 28.6% of the 126 Sucus murinus, 10% of the 10 Rattus rattus and 66.7% of the three Rattus losea. Bacteremia prevalence also varied with the origin of the animals, as 56.2% of the animals captured on farms, 38.6% of the ones captured at harbour sites and 11.8% of the animals captured from urban areas were bacteremic. Through molecular analysis of the gltA gene and 16S/23S intergenic spacer region, genetic diversity of Bartonella organisms was identified, including strains closely related to Bartonella tribocorum, Bartonella grahamii, Bartonella elizabethae, Bartonella phoceensis and Bartonella rattimassiliensis. Moreover, this is the first report of zoonotic B. elizabethae and B. grahamii identified in R. losea, the lesser rice-field rat. Various Bartonella species were identified in R. norvegicus, compared to 97.2% of Suncus murinus with unique Bartonella species. By indirect immunofluorescence antibody test, using various rodent Bartonella species as antigens, consistently low percentage of seropositivity implied that small mammals may play a role as competent reservoirs of Bartonella species in Taiwan. Future studies need to be conducted to determine whether these Bartonella species would be responsible for human cases of unknown fever or febrile illness in Taiwan, especially zoonotic B. elizabethae and B. grahamii.