Search Results (3,133)

To address the major safety hazard that heat released from mining polyurethane (PU) reinforcement materials may induce spontaneous combustion of residual coal in goaf, this study selected No. 3 coal from Wangzhuang Coal Mine, Shanxi Lu’an, as the research object. A self-developed large-capacity, large-scale experimental system was used to conduct programmed heating experiments on 2.0 kg multi-particle-size coal-PU mixed samples. The effects of PU content on characteristic gas release, crossing point temperature (CPT), residue morphology, and TGA-DSC characteristic temperatures were systematically investigated, and the reaction-kinetic evolution was further analyzed using the distributed activation energy model (DAEM). The results show that coal and PU exhibit a significant synergistic enhancement effect during co-heating. As the PU content increased, the release concentrations of CO, C₂H₄, and C₂H₆ increased markedly, and their initial release temperatures decreased, whereas CH₄ generation was inhibited by hydrogen-radical competition; no C₂H₂ was produced below 400 °C. The CPT decreased linearly with an increasing PU content, with an average decrease of approximately 8.5 °C for every 10% increase in PU content. Residue morphology showed clear critical features: glassy agglomerates appeared when the PU content exceeded 16.67%, and dense bulk coking occurred when the PU/coal mass ratio was greater than 1:10. TGA-DSC analysis showed that when the PU/coal ratio was lower than 1:10, the ignition temperature of the mixed sample was higher than that of pure coal, indicating an inhibitory synergistic effect. When the ratio exceeded 1:10, the ignition temperature decreased significantly, and the synergy shifted to promotion; increasing the heating rate shifted the characteristic temperatures to higher values and increased the reaction intensity. DAEM analysis further confirmed that when the PU ratio exceeded 1:10, the apparent activation energy of the mixed samples was lower than that of pure coal. Coal powder also acted as a physical skeleton that effectively dispersed molten PU, eliminated the activation-energy peaks of pure PU in the conversion ranges of 30–50% and 70–90%, and substantially improved combustion stability. Mechanistically, low-temperature PU melting and coating optimized heat and mass transfer, medium-temperature pyrolysis released active radicals and combustible gases that altered coal pyrolysis pathways and the radical reaction environment, and high-temperature hydrogen-radical competition reshaped the gas-product distribution. Together, these processes form a complete chain of synergistic spontaneous combustion. This study identifies key safety threshold parameters for PU reinforcement materials, recommends a PU content of ≤9.10%, and identifies CO and C₂H₄ as priority early-warning gases, providing direct experimental evidence for characteristic-gas-based early warning and mine fire prevention. Full article

Background and Objectives: Rheumatic diseases confer excess cardiovascular risk, yet prognosis after acute coronary syndrome (ACS) in contemporary angiography-treated care remains incompletely characterized, particularly when psychiatric multimorbidity is considered. We evaluated whether documented rheumatic disease was associated with psychiatric comorbidity and post-discharge mortality after ACS. Materials and Methods: We retrospectively analyzed a predefined two-center registry extract of 2950 consecutive patients who underwent coronary angiography for ACS. Documented rheumatic disease was identified from diagnoses recorded in admission history, prior medical records, or discharge documentation and was not re-adjudicated. The primary outcome was post-discharge all-cause mortality. Results: Documented rheumatic disease was present in 106 patients (3.6%). Compared with patients without documented rheumatic disease, exposed patients were older, more often women, more often hypertensive, and more likely to have a documented psychiatric disorder (25.5% vs. 14.1%). Short-term mortality was similar, whereas crude overall long-term mortality was higher (27.4% vs. 19.3%). Among hospital survivors with usable follow-up, post-discharge survival was worse (log-rank p = 0.013). Documented rheumatic disease was associated with higher post-discharge mortality in unadjusted analysis (hazard ratio 1.66, 95% confidence interval 1.11–2.48) and in a prespecified parsimonious model (adjusted hazard ratio 1.56, 95% confidence interval 1.04–2.34); the association attenuated and was no longer statistically significant in a broader exploratory model (adjusted hazard ratio 1.35, 95% confidence interval 0.87–2.07). Documented psychiatric disorder independently predicted mortality. Conclusions: In angiography-treated ACS, documented rheumatic disease was associated with greater psychiatric comorbidity and worse post-discharge survival in a small, documentation-defined, heterogeneous subgroup. Because the signal attenuated in broader exploratory adjustment and exposure ascertainment was documentation-based, the findings should be regarded as hypothesis-generating rather than disease-specific or causal. Full article

Background and Objective: Romosozumab carries a warning for potential severe cardiovascular events, while denosumab is widely used for osteoporosis but requires safety considerations in advanced chronic kidney disease (CKD). Given the limited direct real-world evidence comparing these treatments, in this study, we aimed to compare the cardiovascular and survival outcomes associated with romosozumab versus denosumab in adults with CKD. Materials and Methods: In this retrospective propensity score-matched cohort study, we utilized de-identified electronic health records from the TriNetX Global Collaborative Network, where eligible participants were adults aged 40 to 90 years with CKD who initiated either romosozumab or denosumab. Patients with bone/bone marrow malignancies or recent acute cardiovascular events were excluded. Following 1:1 propensity score matching based on demographics, diagnoses, medications, and laboratory characteristics, patients were followed for up to 1095 days. The primary outcome was a composite cardiovascular measure (all-cause mortality, acute myocardial infarction, or cerebrovascular event), while secondary outcomes included the individual components of the composite outcome and acute heart failure. Outcomes were evaluated using fixed-window cumulative risks, risk ratios (RRs), odds ratios, and hazard-ratio estimates. Results: After 1:1 propensity score matching, 1201 patients remained in each cohort; the mean age was 74.1 years in the romosozumab cohort and 74.2 years in the denosumab cohort, and 94.9% and 93.8%, respectively, were women. Romosozumab was associated with lower 1095-day cumulative risk of the composite cardiovascular outcome than denosumab (12.6% vs. 18.8%; RR, 0.668 [95% CI, 0.553–0.808]), as well as lower cumulative risk of cerebrovascular event (5.0% vs. 7.0%; RR, 0.714 [95% CI, 0.518–0.985]), all-cause mortality (6.6% vs. 9.5%; RR, 0.693 [95% CI, 0.526–0.913]), acute myocardial infarction (3.8% vs. 6.2%; RR, 0.613 [95% CI, 0.429–0.878]), and heart failure (2.7% vs. 6.1%; RR, 0.438 [95% CI, 0.292–0.659]). Conclusions: In this propensity score-matched EHR cohort of adults with CKD, cardiovascular and survival estimates associated with romosozumab versus denosumab varied by follow-up window and analytic approach. Although 1095-day fixed-window cumulative risks were lower in the romosozumab cohort, corresponding time-to-event estimates were neutral or directionally inconsistent. These findings should not be interpreted as evidence of cardioprotection or causal superiority but rather as showing no clear and consistent excess cardiovascular risk signal for romosozumab compared with denosumab. Full article

The occupational health implications of solar photovoltaic (PV) recycling remain critically under-investigated. This study assessed occupational exposure across the PV recycling value chain in Taiwan, evaluating primary mechanical dismantling and downstream reuse sectors (glass milling and controlled low-strength material [CLSM] batching). Area and personal samples were analyzed for total dust, respirable dust, and trace heavy metals. Results indicated that primary mechanical crushing yielded relatively low ambient dust and negligible toxic heavy metal (e.g., Pb, Cd) aerosols, attributed to the macroscopic ductility of metallic ribbons and EVA shock-absorbing properties. Conversely, a critical “hazard transfer” phenomenon was empirically identified downstream, where intensive secondary grinding and aggregate blending in the downstream reuse sector (glass milling and CLSM batching) systematically shifted the aerodynamic particle size distribution, causing the respirable dust fraction to surge to 38.9–72.6%. The pursuit of zero-waste material circularity inadvertently amplifies highly dispersive, respirable dust hazards in downstream sectors, necessitating targeted occupational exposure controls. Full article

Background/Objectives: Tirzepatide is a dual GIP and GLP-1 receptor agonist indicated for the treatment of type 2 diabetes and obesity. Oral delivery of tirzepatide is limited by poor gastrointestinal permeability, pH-dependent solubility, and manufacturing challenges associated with high-dose absorption enhancers. Methods: This study developed an immediate-release oral tirzepatide tablet using a Quality by Design (QbD) approach. Sodium caprate (C10) was selected as the absorption enhancer based on acid-neutralizing capacity, Caco-2 permeability enhancement, and preliminary rat pharmacokinetic screening. Quality target product profile, critical quality attributes, preliminary hazard analysis, and failure mode and effects analysis identified binder/disintegrant ratios as critical material attributes and hammer milling conditions as critical process parameters. Face-centered central composite designs and multiple-response optimization (MRO) were applied to optimize dissolution, flowability, and tablet mechanical integrity. Results: The optimized binder/disintegrant composition produced benchmark-comparable dissolution profiles against oral semaglutide tablets in pH 1.2, 4.0, and 6.8 media, with f₂ values exceeding 50 for both C10 300 mg and 500 mg formulations. The optimized process yielded tablets with low friability (0.58%) and acceptable flowability (Carr’s index, 24). In beagle dogs, the C10 300 mg formulation achieved higher systemic exposure than the C10 500 mg formulation, with a C_max of 46.49 ± 23.79 ng/mL and AUC_last of 1261.03 ± 690.44 h·ng/mL. Conclusion: These results support C10-mediated oral tirzepatide delivery and QbD-based optimization for oral peptide tablets. Full article

Climate change poses significant challenges to urban infrastructure, particularly semi-outdoor stadiums, which are highly susceptible to climate-related hazards. The current research community has gradually recognized this issue but lacks systematic insights into the capacity and methods for stadiums to cope with climate change. This review assesses the vulnerability and climate performance of semi-outdoor stadiums and identifies adaptation strategies to enhance resilience. A systematic literature review was conducted using Web of Science and Scopus databases. Key themes included thermal comfort, wind comfort, and rain protection. Thermal comfort and CFD emerged as the most dominant research focus. This review highlighted the importance of long-term climate adaptation strategies, including the use of sustainable materials, improved ventilation, and renewable energy systems. The results also indicate a lack of research on tropical climates and that more comprehensive adaptation strategies are needed. The core contribution is a structured vulnerability framework that transforms scattered evidence into an integrated knowledge structure, identifying not only dominant themes and missing links but also cross-cutting trade-offs. These findings provide actionable insights for urban planners, architects, and policymakers aiming to enhance stadium resilience and contribute to sustainable urban development goals. Full article

Construction site fires caused by spatiotemporal overlaps between hot work (ignition sources) and combustible substances remain a critical concern. The traditional method identifies fire hazards based on the intersections among hot works and other works with combustible substances. However, the intersections between hot work and built elements containing combustible materials are ignored, which can also lead to fire accidents. In addition, the detection of such intersections relies on the computationally intensive proximity search from the ignition source to the potential combustible substances, resulting in a long-time calculation in large construction projects with the dynamic construction process. To address this limitation, this study proposes a voxel-based fire hazard identification method applicable to large 4D-BIM models, fast and accurately. By discretizing BIM into reusable LEGO voxels, both the construction activities and the building components can be mapped to the voxels, enabling a simultaneous intersection identification between ignition sources and both activities and BIM elements. In addition, voxel-based proximity searching is efficient, enabling a fast and accurate fire hazard identification. Validation tests demonstrate high accuracy with calculatable spatial error (maximum 0.57 m for 200 mm voxels) and superior efficiency (126–1368% faster than mesh-based methods). By reusing the voxelized BIM data, the speed can be enhanced by between 400% and 1975%. This method offers an efficient and reliable digital solution for proactive construction fire safety management in 4D-contexts. Full article

Background and Objectives: Metastatic pancreatic ductal adenocarcinoma (PDAC) continues to carry a poor prognosis despite advances in treatment, underscoring the need for simple and accessible biomarkers that reflect tumor–host interactions. The Global Immune–Nutrition–Inflammation Index (GINI), which combines inflammatory, immune, and nutritional parameters, may offer improved prognostic stratification compared with conventional indices. Materials and Methods: This retrospective cohort study included 126 patients with metastatic PDAC treated between 2015 and 2024. GINI, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated using baseline laboratory data. Discriminative ability was evaluated by receiver operating characteristic (ROC) analysis. Survival outcomes were assessed using Kaplan–Meier curves and Cox proportional hazards models. Results: Among the evaluated indices, GINI showed the best discriminative performance (AUC, 0.769; 95% CI, 0.637–0.900), with a sensitivity of 78.8% and specificity of 76.9%. Patients with lower GINI values had significantly longer overall survival than those with higher values (median OS, 11.0 vs. 7.0 months; p = 0.014). Although progression-free survival differed statistically (p = 0.006), median PFS was the same in both groups (5.0 months). In univariable analysis, higher GINI was associated with worse OS (HR, 1.67; p = 0.022) and PFS (HR, 1.75; p = 0.012). However, in multivariable analysis, ECOG performance status remained the only consistent independent predictor, and GINI was no longer significant. Conclusions: GINI is a practical and biologically meaningful biomarker that improves risk discrimination in metastatic PDAC. While it does not retain independent prognostic significance, its ability to capture the overall tumor–host interaction  supports its use as a complementary tool for baseline risk assessment. Full article

In response to the increasing needs for environmentally friendly products, lignocellulosic natural fibers have been of interest as potential replacements for synthetic reinforcement materials in textiles, composites, and related applications. Among these resources, bast fibers derived from plant stems (flax, hemp, nettle, jute, hop), which contain a high cellulose content, have good mechanical properties, low density, and are renewable, are highly promising. Steam explosion has emerged as a green fiber extraction, defibrillation, and surface modification pretreatment technology. Despite the growing number of studies on steam-exploded natural fibers, a comprehensive understanding of the relationships between processing conditions, fiber modifications, mechanisms, and end-use performance remains limited. This review investigates the structural, chemical, and morphological influences of steam explosion on bast fibers. Specifically, it focuses on the mechanism of steam explosion including the solubilization of hemicellulose, partial lignin redistribution or removal, fiber individualization, and cellulose enrichment. The literature indicates that steam explosion can improve fiber separation, fineness, surface morphology, and interfacial adhesion of the composite materials and reduce the use of hazardous chemicals compared with conventional extraction methods. Nonetheless, conflicting results have also been documented, where the same steam explosion conditions can yield distinct fiber characteristics according to biomass type, composition of biomass, moisture concentration, and the amount of processing involved. Excessive treatment severity may lead to fiber shortening, cellulose degradation, and deterioration of fiber quality, particularly for textile applications requiring long fibers. This review highlights current knowledge gaps regarding the optimization of processing conditions, the understanding of steam explosion mechanisms, and the scale-up of the technology for industrial applications. Full article

Background and Objectives: Malnutrition is highly prevalent among older adults with hip fracture and is associated with poorer surgical outcomes, yet its prognostic relevance is often under-recognized in routine orthopaedic practice. The Controlling Nutritional Status (CONUT) score is an objective laboratory-based screening tool; however, evidence regarding its value for predicting long-term mortality after hip fracture remains limited. This study aimed to evaluate whether nutritional status assessed by the CONUT score independently predicts mortality in older patients with hip fracture. Materials and Methods: This retrospective observational cohort study included consecutive patients aged ≥70 years admitted for hip fracture to a tertiary hospital between 2014 and 2021. Nutritional status was assessed at admission using the CONUT score and categorized as no, mild, moderate, or severe nutritional risk. Demographic characteristics, comorbidity burden, perioperative variables, postoperative morbidity, and mortality up to five years were recorded. Survival was evaluated using Kaplan–Meier methods, and independent predictors of mortality were identified using multivariable Cox proportional hazards models adjusted for clinically relevant confounders. Results: A total of 2798 patients were included (mean age [SD] 84.3 [6.3] years; 26.4% male), of whom 79.2% presented some degree of nutritional risk at admission. Mortality increased overall with worsening nutritional status (p < 0.001). After comprehensive multivariable adjustment, higher CONUT scores remained independently associated with mortality, with each one-point increase associated with an approximately 22% higher risk of long-term death. Poorer nutritional status was also associated with higher postoperative complication rates, greater transfusion requirements, and longer hospital stay. Conclusions: Nutritional status assessed using the CONUT score is an independent predictor of short-, mid-, and long-term mortality in older patients undergoing surgery for hip fracture. Incorporation of objective nutritional screening into orthogeriatric pathways may improve perioperative risk stratification and support targeted multidisciplinary management. Full article

The modification of cementitious binders using active mineral additives and nano-components represents a crucial pathway for developing high-performance, sustainable concrete composites. Nevertheless, unilateral modification of the matrix with highly reactive siliceous materials often leads to an undesirable increase in composite brittleness. This study investigates the synergistic effect of the concurrent application of nano-silica (NS), silica fume (SF), and Class F fly ash (FA) in ternary and quaternary binders, aimed at optimizing both load-bearing capacity and fracture toughness. The experimental program was conducted on seven concrete series, evaluating their mechanical parameters and non-linear fracture properties using the two-parameter fracture model (TPFM) on notched beams subjected to three-point bending. Additionally, a high-resolution energy partitioning framework was applied, decomposing the total fracture energy into four distinct components—fracture initiation energy in the elastic range (G_ini), pre-peak microcracking energy (G_pre), main material softening energy (G_soft), and residual tail energy dissipated at large crack openings (G_tail)—along with the determination of the characteristic length (l_ch). The results demonstrated that while purely siliceous systems (modified with NS and SF) generate high strength increments, they simultaneously trigger a “brittleness trap,” manifested by a 13.65% decrease in the l_ch parameter. The introduction of FA effectively mitigates this hazard, transforming the failure mode into a quasi-ductile behavior. The concrete series modified with the NS+FA hybrid (Mix-5) exhibited a spectacular 107% increase in G_f and an increase in l_ch of nearly 50%, while maintaining high fracture toughness. Energy decomposition analysis in quaternary concretes confirmed a desirable reduction in the initiation energy share in favor of the softening and tail phases (G_tail reaching a record 13.1% for Mix-7), suggesting the probable activation of macroscopic crack-bridging mechanisms driven by the delayed hydration of FA particles. The research indicates that precise design of multi-component binders allows for achieving an optimal technological equilibrium point—the “sweet spot”—combining high structural capacity with safe material ductility. Full article

Background/Objectives: Older adults undergoing surgery for intracranial hemorrhagic lesions after head trauma are clinically heterogeneous, and burr-hole drainage for trauma-related chronic or localized subdural hematoma differs substantially from craniotomy for acute lesions. We evaluated whether a protected-airway local/regional analgesia-dominant strategy (LA), in which airway protection was maintained but continuous maintenance-dose general anesthesia was not planned, was associated with shorter intensive care unit (ICU) stay than conventional general anesthesia (GA). Materials and Methods: In this single-center propensity score-matched retrospective cohort study, 330 patients aged ≥65 years with admission Glasgow Coma Scale (GCS) ≤ 8 who underwent surgery between 2015 and 2024 were analyzed. The LA approach was a pragmatic, jointly selected anesthesiologist–neurosurgeon strategy for carefully selected short burr-hole or localized subdural hematoma procedures; it was not an awake technique and not a protocol of leaving an intubated patient without drugs for airway-device tolerance. A protected airway could include a tracheal tube, supraglottic airway, or preexisting endotracheal tube according to clinical context, and titrated analgesic, sedative, or rescue anesthetic medications were permitted when clinically required. Propensity scores were estimated using age, sex, admission GCS, American Society of Anesthesiologists class, and Charlson Comorbidity Index; lesion category, procedure type, antithrombotic therapy, and intraoperative hypotension were examined as major sources of residual confounding. Results: After matching, the LA group had shorter ICU stay (4 [IQR 2–6] vs. 6 [4–10] days; p < 0.001). Negative binomial regression showed a 28% lower expected ICU stay with LA (incidence rate ratio 0.72, 95% CI 0.58–0.89; p = 0.003), and competing-risk analysis showed faster alive ICU discharge (subdistribution hazard ratio 1.41, 95% CI 1.08–1.84; p = 0.012). Conclusions: In this heterogeneous retrospective cohort, the LA strategy was associated with shorter ICU stay, particularly within selected burr-hole-dominant cases. These findings are hypothesis-generating and should not be interpreted as proof of superiority across acute traumatic brain injury, all lesion types, or all neurosurgical procedures. Full article

Background and Objectives: Systemic inflammatory biomarkers have emerged as potential prognostic indicators in metastatic colorectal cancer (mCRC). However, the prognostic robustness of inflammatory indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), C-reactive protein-to-albumin ratio (CAR), and Glasgow Prognostic Score (GPS) remains incompletely characterized. In this study, we aimed to evaluate the prognostic significance of NLR, PLR, CRP, CAR, and GPS for progression-free survival in metastatic colorectal cancer in a cohort of patients from Romania. Materials and Methods: This retrospective observational study included 148 patients diagnosed with mCRC. Inflammatory biomarkers were determined from baseline laboratory parameters. Progression-free survival (PFS) was the primary endpoint. Statistical analyses included correlation testing, Kaplan–Meier survival analysis, Cox proportional hazards regression, Firth penalized Cox regression, restricted cubic spline modeling, time-dependent receiver operating characteristic (ROC) analysis, LASSO penalized regression, multiple imputation, and parsimonious multivariable Cox models adjusted for major clinicopathologic confounders. Results: Median PFS was 21 months (95% CI 19–24). In univariable Cox analyses, elevated NLR (HR 1.98, 95% CI 1.11–3.51, p = 0.020), PLR (HR 1.89, 95% CI 1.25–2.85, p = 0.002), CRP (HR 1.45, 95% CI 1.15–1.83, p = 0.002), and CAR (HR 1.44, 95% CI 1.05–1.98, p = 0.022) were associated with shorter PFS. Restricted cubic spline analysis demonstrated a significant nonlinear association between NLR and PFS (p = 0.0025). After multiple imputation, NLR remained associated with shorter PFS (HR 2.04, 95% CI 1.13–3.68, p = 0.018). However, in a multivariable model adjusted for major clinicopathologic confounders, this association was not retained (HR 1.41, 95% CI 0.81–2.43, p = 0.221) and time-dependent ROC analyses demonstrated its limited discriminatory performance. Conclusions: Although some inflammatory markers were associated with shorter PFS in univariable analyses, the prognostic effect of NLR was attenuated after adjustment and was not consistently confirmed across all analyses. Full article

Selective separation of quartz and feldspar is vital for high-purity silicate raw materials but is challenging due to similar surface chemistries. Conventional flotation typically requires high reagent dosages and hazardous chemicals, raising environmental and economic issues. This study proposes a sustainable flotation strategy using green, bio-derived reagents to improve quartz–feldspar separation by eco-friendly bio-derived reagents. Sodium oleate, a fatty acid collector, was used with low-toxicity modifiers to create synergistic systems. Flotation performance was tested by reagent dosage and pH, with mineral characteristics analyzed via X-ray Fluorescence (XRF) and Particle Size Distribution (PSD). Results showed that the investigated reagent systems improved the differential flotation response between quartz and K-feldspar. Under the optimized flotation conditions (pH 9.24), quartz recovery reached 84.01%, demonstrating that environmentally friendly reagent combinations can achieve favorable flotation performance while reducing chemical consumption. Response Surface Methodology (RSM) was used to optimize flotation variables like pH and reagent dosage, developing a model to predict conditions for favorable flotation response, enabling systematic process improvement. These findings highlight reagent-system optimization as an eco-friendly method for mineral beneficiation, aligning with green chemistry and sustainable practices. Full article

Background: Chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) are among the most prevalent respiratory disorders worldwide and frequently coexist in the same patient. However, the contribution of active TB and post-tuberculosis lung disease to COPD exacerbations and long-term prognosis remains incompletely defined. Objective: To evaluate the prevalence, clinical correlates, and prognostic significance of tuberculosis and its sequelae in patients with COPD. Materials and methods: We conducted a population-based retrospective cohort study using de-identified data from the regional healthcare information system. The cohort included all adults aged 18 years or older with a recorded diagnosis of COPD (ICD-10 code J44). Tuberculosis was identified by codes A15–A19 and B90. The primary outcomes were COPD exacerbations and all-cause mortality. Group comparisons, cluster analysis, Kaplan–Meier survival analysis, Cox proportional hazards modeling, and multivariable logistic regression were performed. Results: Tuberculosis and/or its sequelae were identified in 267 of 16,714 patients (1.60%): post-TB sequelae (B90) in 197 (73.8%), active TB (A15–A19) in 22 (8.2%), and both in 48 (18.0%). Compared with patients without TB, those with COPD-TB were younger (63.5 ± 14.2 vs. 65.7 ± 14.7 years; p = 0.018), more often male (75.3% vs. 52.0%; p < 0.001), and had higher mortality (16.5% vs. 10.6%; p = 0.003). COPD-TB was associated with bronchiectasis (OR = 6.07; 95% CI, 3.03–12.16), pulmonary fibrosis (OR = 5.67; 95% CI, 3.40–9.45), and pneumonia (OR = 2.01; 95% CI, 1.50–2.71), but with lower prevalences of obesity, diabetes mellitus, and hypertension. Patients with TB experienced more COPD exacerbations, including recurrent exacerbations. In multivariable models, tuberculosis was associated with COPD exacerbations after adjustment for age and sex (adjusted OR = 1.43; 95% CI, 1.05–1.96); this association was attenuated and lost significance after further adjustment for post-tuberculosis structural lung disease, indicating that it is largely mediated by post-TB sequelae. Tuberculosis remained associated with mortality after adjustment for available covariates, both in logistic regression (adjusted OR = 1.61; 95% CI, 1.14–2.28) and in Cox analysis (hazard ratio = 1.37; 95% CI, 1.01–1.85). Conclusions: Tuberculosis and post-tuberculosis lung disease are clinically accessible risk markers associated with COPD exacerbations and mortality. These findings support recognizing patients with COPD and a history of TB as a high-risk subgroup requiring intensified follow-up, proactive exacerbation prevention, and prioritized vaccination counseling. In the context of personalized medicine, a documented history of tuberculosis and post-tuberculosis lung changes represents a clinically accessible marker that can be used to stratify individual risk and to tailor monitoring and prevention in patients with COPD. Full article