Purpose: To determine whether combined performance-based models could exert better predictive values toward discriminating community-dwelling elderly with high risk of any falls or recurrent-falls. Participants and Methods: This prospective cohort study included a total of 875 elderly participants (mean age: 67.10 +/- 5.94 years) with 513 females and 362 males, recruited from Hangu suburb area of Tianjin, China. All participants completed comprehensive assessments. Methods: We documented information about sociodemographic information, behavioral characteristics and medical conditions. Three functional tests-timed up and go test (TUGT), walking speed (WS), and grip strength (GS) were used to create combined models. New onsets of any-falls and recurrent-falls were ascertained at one-year follow-up appointment. Results: In total 200 individuals experienced falls over a one-year period, in which 66 individuals belonged to the recurrent-falls group (33%). According to the receiver operating characteristic curve (ROC), the cutoff points of TUGT, WS, and GS toward recurrent-falls were 10.31 s, 0.9467 m/s and 0.3742 kg/kg respectively. We evaluated good performance as "+" while poor performance as "-". After multivariate adjustment, we found "TUGT 0.3742 kg/ kg, WS 0.9467 m/s" showed strongest correlation with both any-falls (adjusted OR=5.499; 95%CI=2.982-10.140) and recurrent-falls (adjusted OR=8.260; 95%CI=3.880-17.585). And this combined functional model significantly increased discriminating abilities on screening recurrent-fallers than a single test (C-statistics=0.815, 95%CI=0.782-0.884, P<0.001), while not better than a single test in predicting any-fallers (P=0.083). Conclusion: Elderly people with poor TUGT performance, weaker GS but quicker WS need to be given high priority toward fall prevention strategies for higher risks and frequencies. Meanwhile, the combined "TUGT-, GS-, WS+" model presents increased discriminating ability and could be used as a conventional tool to discriminate recurrent-fallers in clinical practice.

This study aims to explore the single and joint effects of depression and malnutrition on the incidence of first fall onset in a Chinese community-dwelling elderly population. This cohort study consisted of 739 residents without a history of falls who were aged 60 years and older (mean age: 67.08 +/- 5.79 years, female: 58.2%). Depression was defined with the Geriatric Depression Scale (GDS)-30; a score of >= 11 was considered to be depressed, while malnutrition was defined with the Mini Nutritional Assessment where a score <17 was defined as malnourished. Over a 2-year follow-up period, older adults who experienced at least one fall were allocated to the first fall onset group. The prevalence of baseline falls was 21.36%. During the 2-year follow-up, incidence of first fall onset was 13.13%. After adjusting for all confounders, depression alone (adjusted odds ratio [OR] = 3.545, 95% confidence interval [CI] = 1.318-9.535) and malnutrition alone (adjusted OR = 2.204, 95% CI = 1.183-4.108) were observed to be independent risk factors for first fall onset, while comorbidity of depression and malnutrition showed progressively increased risk of promoting first fall (adjusted OR = 8.161, 95% CI = 3.591-18.545) than those with only depression or malnutrition or without both depression and malnutrition. Malnutrition mediated 56% effects in the association between depression and first fall onset, while depression mediated 76% effects in the promoting role of malnutrition in first fall. Depression and malnutrition were found to be independent causes for promoting first fall, while mental health and nutrition should be treated as commonly prior interventions to delay first fall onset. Meanwhile, for malnourished Chinese community-dwelling older adults, avoidance or treatment of depression should be addressed at first.

Purpose: Currently there is no consensus on the correlation between metabolic syndrome (MetS) and muscle strength. The objective of this study was to examine the associations between MetS and its components and different handgrip strength (HS) indexes among Chinese community-dwelling elderly individuals. In addition, we hoped to find an optimal cutoff point for the index most relevant to MetS. Methods: Data were obtained from 909 participants aged >= 60 years (385 men, average age, 68.0 +/- 5.9 y). We used the International Diabetes Federation metabolic syndrome guidelines to define MetS. General data of all participants were collected through questionnaires and anthropometric data were measured. At the same time, blood samples were collected. Results: The prevalence of MetS was 26.8 % in men and 46.9 % in women. In all HS indexes, HS/body fat mass was most strongly correlated with MetS, and the areas under the receiver-operating characteristic curve were 0.723 (95 % confidence interval [CI] = 0.669-0.776) in men and 0.619 (95 % CI = 0.571-0.667) in women, and the optimal cutoffs were 1.92 in men and 1.25 in women. The adjusted odds ratios (ORs) of MetS for low HS/body fat mass were 5.38 (95 % CI = 3.03-9.56, p < 0.001) in men and 2.39 (95 % CI = 1.56-3.64, p < 0.001) in women. Conclusions: HS/body fat mass appears to be the index best associated with MetS and its components, and in men it is more relevant than in women.

Objective Osteoporosis can lead to bone fragility and an increased risk of bone fracture with resultant high morbidity and mortality. Living alone has been associated with various mental and physical health problems. However, the risk of osteoporosis among individuals with different living conditions and changing living conditions is unclear. We examined the risk of osteoporosis in different living conditions over a 3-year period in community-dwelling suburban elderly Chinese. Methods This study involved 288 elderly Chinese suburb-dwelling participants with no documented history of osteoporosis. All were aged ≥60 years (mean, 65.6±3.75 years; 157 men). A quantitative ultrasound scan of the calcaneus with a T score of <−2.5 was used to identify a high risk of osteoporosis. Results In total, 54.2% of participants were determined to have a high risk of osteoporosis (male, 51.6%; female, 57.3%). People who had always lived alone had a significantly higher risk of osteoporosis, even after adjusting for potential confounders. A change from living alone to living with others had no significant impact on the risk of osteoporosis. Conclusion Our results indicate that living alone is associated with a high risk of osteoporosis. Thus, people who live alone may need regular bone tests to avoid adverse events.

Epidemiological studies report that more than half of the people over the age of 65 years suffer from variable sleep problems. In this study, we conducted a cohort study to investigate the relationship between sleep duration, muscle mass, and function within a community-dwelling, elderly Chinese population. Our study population consisted of residents living in the township central hospital of suburban Tianjin, China. We measured muscle strength and walking speed. We divided sleep duration into the following four groups: <7 hours, 7-8 hours, >8-9 hours, and >9 hours. A total of 902 participants completed the 3-year follow-up. We observed a U-shaped relationship between sleep duration and fall risk. Compared with the 7-8-hour group, fall risk within the <7-hour group was 3.67 (2.59, 5.42) times higher and fall risk within the >9-hour group was 2.35 (1.29, 3.52) times higher. After adjustment, muscle mass declined by -6.82% (-11.27%, -3.83%) in the <7-hour group. In summary, we observed a U-shaped relationship between sleep duration and falls. Short sleep duration has a negative relationship with muscle mass decline in a community-dwelling, elderly Chinese population.

Background: Heart rate variability (HRV) provides indices related to all types of risks for death, increased risk of cardiovascular disease and diabetes, especially in elderly. Obesity and grip are related to diseases, thus decrease elderly healthy life. However, there is no definitive link between HRV and muscle strength and obesity. We conducted a cross-sectional study to determine whether grip strength and obesity are associated with HRV in elderly, community-dwelling Chinese individuals.Method: Our study population consisted of residents of Township Central Hospital of Chadian, Tianjin, China. We measured short term HRV, grip strength, and body mass index (BMI). The HRV measures were transformed to the natural log to normalize the distribution and we used logistic regression to explore the relationship.Results: A total of 534 participants over the age of 60 (200 men, mean age 69.2±6.0) had complete data at the baseline and were included in the analysis. Compared with the isolated-obesity group and isolated-low-grip-strength group, the group with concurrent obesity and low grip strength has a stronger relation with LF n.u.[0.94(0.90-0.98)], ln(LF) [0.50(0.29-0.95)], and ln(LF/HF) [0.41(0.20-0.83)].Conclusion: Our results demonstrate that low HRV is associated with concurrent low grip strength and obesity in older adults, rather than isolated low grip strength or isolated obesity. These results may provide a reference for early screening of cardiac autonomic function disorders in patients with potential heart disease in clinic, thus contributing indirectly to the prevention or rehabilitation of cardiovascular disease. It also provides a new idea for further mechanism research.Clinical trial registry Our research was registered on Research Registry website (URL: http://www.chictr.org.cn/index.aspx ), the registry number was ChiCTR1800016308.

Background The short physical performance battery (SPPB) has played an important role in establishing a linkage between body function and health. Aims The aim of this study was to evaluate the predictive value of the SPPB summary score and its three components for screening prolonged hospitalization for coronary artery bypass grafting (CABG) in older patient candidates. Methods This study included 188 consecutive elderly patients (aged ≥ 60 years) undergoing elective CABG surgery and all the patients were assessed for SPPB. Stepwise regression was employed to analyze the association of postoperative length of hospital stay (LOS) with SPPB. The validity of SPPB scores were assessed by ROC curves to analyze the sensitivity and specificity for identifying elderly patients with prolonged hospitalization. ResultsAlthough SPPB and three components of SPPB all were independent risk factors of prolonged hospitalization, only the SPPB summary score and the 4-meter gait speed components showed good discriminative capabilities. A SPPB summary score cutoff of 10 provided the best accuracy for identifying prolonged hospitalization. The net benefit of model 2 (Model 1 combined with SPPB cut-off score) was better than that of the model 1 that had threshold probabilities of 30%–100%. Conclusions This study provided evidence for the clinical utility of the SPPB summary score and 4MGS test for prolonged hospitalization in elderly patients undergoing CABG. These tests also showed potential as a screening test for identifying elderly patients undergoing CABG who are at risk of prolonged hospitalization mobility.

Objective: The objective of this study was to examine the incidence of new onset depressive symptoms and associated factors over a 1-year period in an older Chinese suburban population. Design: Prospective cohort study. Setting and Participants: The sample comprised 691 Chinese community-dwelling participants (304 men; mean age 67.5 +/- 5.7 years) without depressive symptoms at baseline, recruited from Chadian of Tianjin, China. Measures: We had documented detailed information regarding sociodemographics, behavioral characteristics, and medical conditions. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria. The outcome was new onset depressive symptoms at 1-year follow-up, defined as a score of >= 11 on the 30-item Geriatric Depression Scale. Results: We found that 83 (12.0%) of the 691 participants without depressive symptoms at baseline had developed depressive symptoms. After multivariate adjustments, it was found that the incidence of new onset depressive symptoms was associated with sarcopenia, type 2 diabetes mellitus, and cardiovascular disease. People with a higher level of muscle mass and better sleep quality were significantly less likely to develop depressive symptoms than their counterparts. Conclusions/Implications: We found that the incidence of depressive symptoms increased with some chronic diseases, such as sarcopenia, type 2 diabetes mellitus, and cardiovascular disease. In addition, muscle mass was the most related protective factor among sarcopenia's 3 basic diagnosis components-muscle mass, muscle strength, and physical performance. Hence, maintaining enough muscle mass could be beneficial in the prevention of depressive symptoms for older adults. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Background: Although perioperative care during heart surgery has improved considerably, the rate of postoperative complications has remained stable. It has not been concluded how to better apply grip strength to clinical, postoperative complications. So our study aimed at researching the best way for using grip value for predicting early postoperative complications.Methods: A total of 212 patients with mean age 63.8±6.3 who underwent cardiac surgery participated in our study. We analyzed the ROC curve of grip strength, grip/weight and grip recovery with complications, found the best cutoff point. Logistic regression confirmed the association between grip strength grouping and complications.Results: We found that 36 patients had 30-day complications. EuroSCORE were 2.15±1.52 and 2.42±1.58 between normal and complication groups, respectively. The area under the receiver-operating characteristic curve (AUC) of grip recovery take the most area (0.837, p<0.001), and the cutoff point was 83.92%. In logistic regression, lower grip recovery has higher risk impact on 30-day complications for 25.68 times than normal group, after adjusted surgery-related factors. After regrouped characteristic information by grip recovery cutoff point , we found that percentage of the estimated 6 minute walk distance (41.5 vs 48.3, p=0.028) and hospitalization time (7.2 vs 6.1, p=0.042) had worse trends in lower recovery group.Conclusions: Poor grip recovery may be related to higher risk of postoperative complications within 30 days after discharge in middle-aged and older people independent of surgical risk. The results of this study provide a reference for the development of rehabilitation programs in the early postoperative recovery, and may also be a prognostic indicator for postoperative high-risk groups.

The objective of this study was to determine falls risk profiles to derive a falls risk prediction score and establish a simple and practical clinical screening tool for Chinese community-dwelling elderly individuals. This was a prospective cohort study (n = 619) among adults aged 60 years and older. Falls were ascertained at a 1-year follow-up appointment. Sociodemographic information, medical history, and physical performance data were collected. The mean age was 67.4 years; 57.7% were women. Female sex (odds ratios [ORs] 1.82; 95% confidence interval [95% CI] 1.17-2.82), diabetes (OR 2.13; 95% CI 1.13-3.98), a Timed Up and Go Test (TUGT) ≥10.49 seconds (OR 1.51; 95% CI 1.23-1.94), a history of falls (OR 3.15; 95% CI 1.72-5.79), and depression (Geriatric Depression Scale [GDS] ≥11, OR 2.51; 95% CI 1.36-4.63) were the strongest predictors. These predictors were used to establish a risk score. The area under the curve of the score was 0.748. From a clinical point of view, the most appropriate cutoff value was 7 (97.5% specificity, 70.7% positive predictive value, and 83.6% negative predictive value). For this cutoff, the fraction correctly classified was 82.5%. A cutoff score of 7 derived from a risk assessment tool using four risk factors (gender, falls history, diabetes, and depression) and the TUGT may be used in Chinese community-dwelling elderly individuals as an initial step to screen those at low risk for falls.

Background The aim of the present study was to examine the risk factors for developing diabetes after 3 years in an elderly Chinese suburban population with impaired fasting glucose (IFG). Methods The study population comprised residents of the Hangu area of Tianjin, China, with IFG, aged >= 60 years, who joined the national free physical examination program (n = 328; mean [+/- SD] age 68.0 +/- 6.1 years; 48.2% men). Diabetes was defined by self-report of a physician's diagnosis or fasting plasma glucose (FPG) >= 7.0 mmol/L; IFG was defined as FPG >= 5.6 and < 7.0 mmol/L. Risk factors of incident diabetes at the 3-year follow-up were analyzed individually using logistic regression analysis. Results Between baseline and the 3-year follow-up, 56 subjects with IFG at baseline had developed diabetes. After multivariate adjustment for demographic and clinical factors, the incidence of diabetes increased with higher FPG (odds ratio [OR] 9.30, 95% confidence interval [CI] 2.84-30.48), but decreased with the grip strength/weight ratio (OR 0.88, 95% CI 0.82-0.94). Moreover, the combination of higher FPG and lower grip strength/weight was associated with a higher incidence of diabetes than higher FPG only or lower grip strength/weight (P < 0.05). Conclusion The present study indicates that higher FPG and lower muscle strength are associated with glycemic deterioration among subjects with IFG after 3 years. The results suggest that not only glucose levels, but also physical performance may be useful markers of the risk of diabetes in this population.

Even though stroke is the third, not the first, most common cause of disability-adjusted life years in developed countries, it is one of the most expensive to treat. Part of the expense is due to secondary problems in the post-stroke period including: cognition, memory, attention span, pain, sensation loss, psychological issues, and problems with mobility and balance. Research has identified that exercise has both positive physical and psychosocial effects for post-stroke patients. Therefore, this scientific statement provides an overview on exercise rehabilitation for post-stroke patients. We will use systematic literature reviews, clinical and epidemiology reports, published morbidity and mortality studies, clinical and public health guidelines, patient files, and authoritative statements to support this overview. Evidence clearly supports the use of various kinds of exercise training (e.g., aerobic, strength, flexibility, neuromuscular, and traditional Chinese exercise) for stroke survivors. Aerobic exercise, the main form of cardiac rehabilitation, may play an important role in improving aerobic fitness, cardiovascular fitness, cognitive abilities, walking speed and endurance, balance, quality of life, mobility, and other health outcomes among stroke patients. Strength exercise, included in national stroke guidelines and recommended for general health promotion for stroke survivors, can lead to improvements in functionality, psychosocial aspects, and quality of life for post-stroke patients. Flexibility exercises can relieve muscle spasticity problems, improve motor function, range of motion, and prevent contractures. Stretching exercises can also prevent joint contractures, muscle shortening, decrease spasticity, reduce joint stiffness and improve a post-stroke patient’s overall function. Neuromuscular exercises can improve activities of daily living (ADL) through coordination and balance activities. Traditional Chinese exercises are used to improve walking and balance ability as well as increase muscle strength, which is important for post-stroke patients. The present evidence strongly supports the power of exercise for post-stroke patients, which in this study combined aerobic exercises, strength training, flexibility exercises, neuromuscular exercises, and traditional Chinese exercises. This research can encourage post-stroke survivors to consider the importance of exercise in the rehabilitation process.

Background: Reduced muscle strength, as measured by handgrip strength (HS), has been associated with an increased risk of cardiovascular disease (CVD). The aim of this study was to examine the association between different HS indexes and CVD risk factors in elderly Chinese individuals. We also determine optimal cutoffs of HS indexes for predicting CVD risk factors. Methods: Data were obtained from 603 men and 789 women aged >= 60 years (average age 66.8 +/- 6.4 y). These study participants were recruited in the suburb area of Tianjin, China. An individual was considered a patient when they exhibited any one of three CVD risk factors: diabetes mellitus, hypertension and dyslipidemia. All participants were interviewed face-to-face. In addition, serum samples were collected from all participants, and all participants underwent measures of anthropometry and HS. Results: The optimal cutoffs were 0.376 of HS/weight in men and 0.726 of HS/body fat mass in women for predicting diabetes mellitus. The adjusted odds ratios (ORs) of at least one CVD risk factor for those with low muscle strength identified by HS/body fat mass were 2.14 (95% confidence interval [CI]: 1.53, 3.44; p < 0.001) in men and 2.32 (95% CI: 1.60, 3.29; p < 0.001) in women. Conclusion: HS/body fat mass appear to be the index best associated with CVD risk factors except diabetes mellitus in men. The optimal cutoffs of HS indexes have the potential to identify elderly adults at risk of CVD. Copyright (C) 2018, Formosan Medical Association. Published by Elsevier Taiwan LLC.

Background Physical performance is an important healthy factor in elder people. Good living habits, which include sleep, can maintain physical strength and physical performance. The aim of the present study was to conduct a cross-sectional study to determine the association between total sleep duration and physical performance. Methods Our study population comprised residents of the township central hospital in the suburban of Tianjin, China. We measured muscle strength, walk speed and balance function by grip, 4-m walk test and timed up and go test (TUGT). We divided sleep duration into four groups <7h, 7-8h, >8-9h, >9h. Results A total 898 participants had completed data (392 men and 506 women, mean age 67.71 years). In man, adjusted sleep duration was associated with lower grip in > 9 h group, the mean value (95% CI) was 0.429 (0.409, 0.448), and longer TUGT time was also associated with long sleep duration, 10.46s (9.97 s, 10.95 s). In women, adjusted slower 4-m walk speed present an inverse U-shaped relation with sleep duration, by 0.93 m/s (0.86 m/s, 0.98 m/s), 0.97 m/s (0.96 m/s, 1.00 m/s), 0.97 m/s (0.95 m/s, 0.99 m/s) and 0.92 m/s (0.89 m/s, 0.96 m/s); longer TUGT time were associated with long sleep duration (> 9 h), by 11.23 s (10.70 s, 11.77 s). Conclusion In Chinese community-dwelling elderly, lower muscle strength and lower balance function were associated with long sleep duration in men. Slower walk speed and lower balance function were associated with long sleep duration in women.

The aim of the present study is to investigate the relationship between sarcopenia and cardiovascular risk factors (CVRF) in the Chinese elderly. A total of 1611 elderly individuals aged ≥60 years were enrolled in this study. The well-established CVRF of diabetes, hypertensions, and dyslipidemia were assessed. Sarcopenia was defined according to the recommended algorithm of the Asian Working Group for Sarcopenia (AWGS). Multiple logistic regression analyses and the linear regressions were used to evaluate the components of CVRF and the number of CVRF of elderly patients with sarcopenia. After adjusting for potential confounders, CVRF was associated with a high prevalence of sarcopenia in elderly Chinese populations. Furthermore, diabetes and hypertension, but not dyslipidemia, were found to be significantly associated with sarcopenia. The OR and 95% CI for sarcopenia of the participants with 1, 2, and 3 features of CVRF were 2.27(1.14–4.48), 4.13(1.80–9.46), and 4.90(1.01–23.81), respectively. A linear increase in the prevalence of sarcopenia was found to be associated with the number of CVRF components in the elderly population ( P values for the trends < 0.001). Knowledge of known CVRF, particularly diabetes and hypertension, may help predict the risk for sarcopenia in the elderly.

Purpose Falling is a major health problem in community-dwelling elderly individuals. The aim of the present study was to conduct a prospective investigation to evaluate the accuracy of the Timed Up and Go Test (TUGT), 4-meter walking test, and grip strength test to screen for the risk of falls and to determine a cutoff point to be used clinically. Patients and methods This was a prospective study that included 541 participants. The fall data were obtained via face-to-face interview, and the date, site, and circumstances of any falls were recorded. TUGTs were recorded as part of a comprehensive geriatric assessment. We collected the same data at baseline and after follow-up via comprehensive geriatric assessment. Results The incidence of falls of our study subjects was 20.8%. The recurrent-fall group had a fall rate of 6.8% during the follow-up year. The standard area under the curve (AUC) of our screening tool was >0.70, and hence our tool can be used for clinical purposes. After adjusting for age and gender, the AUC of TUGT became 0.642, so it cannot be used as a predictive tool for measuring any types of falls. However, when recurrent falls were adjusted for age and gender, the TUGT’s AUC improved to 0.733 and a score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals. Conclusion Future falls were best predicted by TUGT in recurrent fallers at baseline. A score of 15.96 seconds is used as a cut-point to screen recurrent falls in community-dwelling elderly Chinese individuals.

This article aims to examine the effect of mobility limitation and obesity on the risk of new incidence of type 2 diabetes mellitus (T2DM) and mortality. The design was a cohort study (n = 1075) among adults aged 60 years and older. Obesity was defined as body-mass index greater than or equal to 28 kg/m2. Mobility limitation was defined as participants scoring in the top 20% on the timed up and go test or in the slowest 20% for the 4-m walking test. The mean age of the study population was 67.4 ± 5.4 years (age range: 60-86 years), and 57.4% were women. Overall, 5.1% of women and 1.9% of men had both obesity and mobility limitations. During 3-year follow-up, the new incidence of T2DM was 2.98% and the adjusted risk of the new incidence of T2DM was progressively greater in obese subjects without mobility limitation, but not greater in the single mobility limitation subjects. The combination of mobility limitation and obesity (odds ratio = 10.3, 95% confidence interval = 2.25-70.13) has a significantly higher risk than obesity only or mobility limitation only. What is more, obesity with mobility limitation could be an independent predictor of 3-year mortality compared with the other subjects. We demonstrated the associations between obesity and mobility limitation and thus the increased risk of developing, with the combination over time, T2DM and mortality.

Background: Assessment of the association of muscle strength and muscle mass with osteoporosis (OP) is of special interest as muscles are a potential target for interventions (i.e., strength training). Methods: A cross-sectional descriptive study encompassing people aged >= 60 years (average age: 66.9 +/- 6.2 years; men, n = 516; women, n = 652) in the Hangu area of Tianjin, China. The study populations were invited to participate in a comprehensive geriatric assessment. OS was identified by measuring the calcaneal using a quantitative ultrasound and a T score of less than -2.5. Muscle characteristics included grip strength and appendicular skeletal muscle mass (ASM). Results: The prevalence of OS in this study was 61.6% (male 52.1%, female 69.1%). Grip strength was negatively related to OS and after adjusting for all other variables, higher grip strength was found to be associated with a lower OS risk (p = 0.023). ASM/height(2) was not associated with OS (p = 0.205). Conclusion: Based on our study, muscle strength rather than muscle mass is negatively associated with OS in older people; thus, we should pay more attention to muscle strength training in the early stage of the OS. Copyright (C) 2017, Formosan Medical Association. Published by Elsevier Taiwan LLC.

Skeletal cryptococcosis, an aspect of disseminated cryptococcal disease or isolated skeletal cryptococcal infection, is a rare but treatable disease. However, limited information is available regarding its clinical features, treatment, and prognosis. This systematic review examined all cases published between April 1977 and May 2013 with regard to the factors associated with this disease, including patient sex, age, and epidemiological history; affected sites; clinical symptoms; underlying diseases; laboratory tests; radiological manifestations; and delays in diagnosis, treatment, follow-up assessments, and outcomes. We found that immune abnormality is a risk factor but does not predict mortality; these observations are due to recent Cryptococcus neoformans var gattii (CNVG) outbreaks (Chaturvedi and Chaturvedi, 2011). Dissemination was irrespective of immune status and required combination therapy, and dissemination carried a worse prognosis. Therefore, a database of skeletal cryptococcosis cases should be created.