Search Results (2,087)

Background and Objectives: Sentinel lymph node (SLN) mapping is an established alternative to systematic lymphadenectomy for early-stage endometrial cancer (EC). While retroperitoneal vNOTES affords direct access to pelvic nodes without abdominal incisions, data regarding its oncologic validity remain sparse. This study evaluates the SLN detection rates, perioperative outcomes, and 12-month oncologic outcomes oncologic results of retroperitoneal vNOTES mapping in presumed early-stage EC. Materials and Methods: This single-center retrospective cohort study analyzed consecutive patients undergoing retroperitoneal vNOTES staging (hysterectomy, BSO, and SLN mapping) for presumed EC between February 2023 and January 2024. Eligible patients had radiologically uterine-confined disease and were candidates for transvaginal surgery. Following cervical methylene blue injection, SLN mapping was executed via the retroperitoneal vNOTES route. Mapped and suspicious nodes were excised, with side-specific lymphadenectomy performed for failed mapping per algorithm. While perioperative outcomes were assessed for the full cohort, oncologic analyses (FIGO 2023 staging, nodal metastasis) were restricted to patients with confirmed carcinoma. Results: Of 98 patients (median age 54; BMI 31 kg/m²), final pathology confirmed carcinoma in 78 (73 endometrioid, 5 serous) and EIN in 20. Bilateral SLN mapping succeeded in 87.8% (86/98), necessitating side-specific lymphadenectomy in the remaining 12.2%. The obturator fossa was the predominant nodal basin (43.9%). Within the carcinoma cohort (n = 78), 57.7% were Grade 1 and 74.4% FIGO Stage I. Nodal metastases (FIGO IIIC1) were identified in 12.8% (10/78), all prompting adjuvant therapy. At a median follow-up of 12 months, no disease recurrences were observed. The complication rate was 6.1% (5.1% Clavien–Dindo ≥ III), with no conversions required. At 12-month follow-up, no recurrences were detected, though the absence of systematic lymphadenectomy precluded formal sensitivity analysis. Conclusions: Retroperitoneal vNOTES represents a feasible and safe strategy for SLN mapping in early-stage EC, demonstrating high bilateral detection with minimal morbidity. However, reliance on methylene blue and limited follow-up necessitate caution. Broader implementation requires validation through prospective, comparative trials utilizing indocyanine green and long-term oncologic surveillance. Full article

Bioprocessing grape pomace (GP) presents a sustainable solution aligned with circular economic principles and transforms it into valuable functional ingredients for baked products. This review (2020–2025) synthesizes enzymatic and microbial strategies that modify the fiber–phenolic matrix and improve dough performance. Enzyme-assisted extraction, alone or combined with ultrasound or pressurized liquids, increases extractable polyphenols and antioxidant capacity in GP fractions used as flour substitutions or pre-ferments. Fungal solid-state and lactic fermentations liberate bound phenolic compounds and generate acids and exopolysaccharides. Among these routes, enzyme-assisted extraction and lactic sourdough-type fermentations currently appear the most compatible with bakery-scale implementation, offering substantial phenolic enrichment while relying on relatively simple, food-grade equipment. In current bakery applications, GP is mainly used as crude grape pomace powder, which typically shows higher total phenolics and antioxidant capacity. Moreover, in several models it lowers starch hydrolysis and predicted glycemic index. The practical substitution rate is between 5 and 10% of flour, which balances nutritional gains with processing disadvantages. These can be mitigated by fractionation toward soluble dietary fiber or co-fortification with flours rich in protein and fiber. An additional benefit of these methods includes reduced mycotoxin bioaccessibility in vitro. A key evidence gap is the absence of standardized comparisons between raw and bioprocessed GP in identical formulations. Overall, GP emerges as a promising ingredient for bakery products, while the added technological and nutritional value of bioprocessing remains to be quantified. Full article

Understanding extreme precipitation (EP) evolution is crucial for global climate adaptation and hazardous disasters prevention. However, spatial non-stationarity of urbanization relationships with EP variations has been rarely discussed in a complex topographic context. Taking the city Liuzhou in China as the example, this study separately quantified the evolution of EP intensity, magnitude, duration, and frequency on different temporal scales with Innovative Trend Analysis (ITA). Based on a finer spatial (5 km grid) scale and multiple temporal (daily, daytime, nighttime, and 14 h) scale analyses, it innovatively identified spatially varying urbanization effects on EP with more details in different elevations. Our results indicate that: (1) from 2009 to 2023, EP events became more intense, persistent, and frequent, particularly for higher-grade EPs and in the steeper north of Liuzhou; (2) despite the globally negative correlations, spatial correlations between comprehensive urbanization (CUB) and each EP index on individual temporal scales were still explicitly categorized into four types using LISA maps—high-high, high-low, low-low, and low-high; (3) Geographically Weighted Regression (GWR) was demonstrated to precisely explain the response of most EP characteristics to multiple manifestation of urbanization with respect to population (POP), economy (GDP), and urban area (URP) expansion (adjusted R²: 0.5–0.8). The predictive accuracy of GWR on urbanization and EPs was spatially non-stationary and variable with temporal scales. The local influential strength and direction varied significantly with elevations. The most significant and positive influences of three urbanization predictors on EPs occurred at different elevation grades, respectively. Compared with POP and GDP, urban area percent (URP) was indicated to positively relate to EP changes in more areas of Liuzhou. The spatial and quantitative relationships between urbanization and EPs can help to guide effective urban planning and location-specific management of flood risks. Full article

Cracks serve as a critical indicator of tunnel structural degradation. Manual inspections are difficult to meet engineering requirements due to their time-consuming and labor-intensive nature, high subjectivity, and significant error rates, while traditional image processing methods exhibit poor performance under complex backgrounds and irregular crack morphologies. To address these limitations, this study developed a high-quality dataset of tunnel crack images and proposed an improved lightweight semantic segmentation network, LiteSqueezeSeg, to enable precise crack identification and quantification. The model was systematically trained and optimized using a dataset comprising 10,000 high-resolution images. Experimental results demonstrate that the proposed model achieves an overall accuracy of 95.15% in crack detection. Validation on real-world tunnel surface images indicates that the method effectively suppresses background noise interference and enables high-precision quantification of crack length, average width, and maximum width, with all relative errors maintained within 5%. Furthermore, an integrated intelligent detection system was developed based on the MATLAB (R2023b) platform, facilitating automated crack feature extraction and standardized defect grading. This system supports routine tunnel maintenance and safety assessment, substantially enhancing both inspection efficiency and evaluation accuracy. Through synergistic innovations in lightweight network architecture, accurate quantitative analysis, and standardized assessment protocols, this research establishes a comprehensive technical framework for tunnel crack detection and structural health evaluation, offering an efficient and reliable intelligent solution for tunnel condition monitoring. Full article

Modern cryptographic systems increasingly depend on certified hardware modules to guarantee trustworthy key management, tamper resistance, and secure execution across Internet of Things (IoT), embedded, and cloud infrastructures. Although numerous FIPS 140-certified platforms exist, prior studies typically evaluate these solutions in isolation, offering limited insight into their cross-domain suitability and practical deployment trade-offs. This work addresses this gap by proposing a unified, multi-criteria evaluation framework aligned with the FIPS 140 standard family (including both FIPS 140-2 and FIPS 140-3), replacing the earlier formulation that assumed an exclusive FIPS 140-3 evaluation model. The framework systematically compares secure elements (SEs), Trusted Platform Modules (TPMs), embedded Systems-on-Chip (SoCs) with dedicated security coprocessors, enterprise-grade Hardware Security Modules (HSMs), and cloud-based trusted execution environments. It integrates certification analysis, performance normalization, physical-security assessment, integration complexity, and total cost of ownership. Validation is performed using verified CMVP certification records and harmonized performance benchmarks derived from publicly available FIPS datasets. The results reveal pronounced architectural trade-offs: lightweight SEs offer cost-efficient protection for large-scale IoT deployments, while enterprise HSMs and cloud enclaves provide high throughput and Level 3 assurance at the expense of increased operational and integration complexity. Quantitative comparison further shows that secure elements reduce active power consumption by approximately 80–85% compared to TPM 2.0 modules (<20 mW vs. 100–150 mW) but typically require 2–3× higher firmware-integration effort due to middleware dependencies. Likewise, SE050-based architectures deliver roughly 5× higher cryptographic throughput than TPMs (∼500 ops/s vs. ∼100 ops/s), whereas enterprise HSMs outperform all embedded platforms by two orders of magnitude (>10 000 ops/s). Because the evaluated platforms span both FIPS 140-2 and FIPS 140-3 certifications, the comparative analysis interprets their security guarantees in terms of requirements shared across the FIPS 140 standard family, rather than attributing all properties to FIPS 140-3 alone. No single architecture emerges as universally optimal; rather, platform suitability depends on the desired balance between assurance level, scalability, performance, and deployment constraints. The findings offer actionable guidance for engineers and system architects selecting FIPS-validated hardware for secure and compliant digital infrastructures. Full article

Background and Objectives: Robot-assisted procedures represent a significant advancement in minimally invasive liver resection techniques. Nonetheless, the introduction of a novel surgical technique in a new environment necessitates meticulous planning and a gradual, stepwise approach. This study describes the adoption of a robotic surgical platform for liver resection at a high-volume tertiary care center. Materials and Methods: We retrospectively analyzed data that had been prospectively collected from fifty robot-assisted liver resections. Descriptive statistics, including frequencies, percentages, means/medians, and standard deviations, were employed for description and summary. Results: The median operative duration was 166 min (range: 85–400 min), with an average intraoperative blood loss of 200 mL (range: 50–1000 milliliters). Intraoperative or postoperative blood transfusion was required in 8% of patients. Conversion to open resection was necessary in one patient (2%). The mean duration of hospitalization was 5 days (range: 3–20 days), with a 30-day readmission rate of 6% and no mortality within 90 days. Postoperative complications classified as Clavien-Dindo grade 3 or higher were observed in five patients (10%). The mean tumor size varied according to pathology: 58.5 mm (range: 30–120 mm) in the hepatocellular carcinoma group; 27.4 mm (range: 10–32 mm) in the secondary malignancy group; and 42.6 mm (range: 24–60 mm) in the intrahepatic cholangiocarcinoma group. The median number of lymph nodes harvested during lymphadenectomy (IHHCA/GBCA) was 5.4, ranging from 1 to 11. The R0 resection rate for malignant tumors was 88.2% (of 30/34). Conclusions: This study validates the safe integration of robot-assisted surgery into liver disease treatment, supported by our initial experience. Despite its technical advantages, robotic-assisted liver surgery remains complex and demanding. Structured robotic training within established programs, meticulous patient selection, and a stepwise implementation approach are critical during the early phases to optimize the outcomes. Full article

Geochemical whole-rock variations in the Kovdozero complex in the Lapland–Belomorian Belt (LBB) are compared with those observed in the Pados-Tundra layered complex in the Serpentinite Belt (SB) in the complementary structure in the Fennoscandian Shield. A great variety of coronitic associations exists in the entire LBB–SB system. The Kovdozero complex largely consists of more evolved products of crystallization. Our results of U–Pb dating (zircon and baddeleyite) give the dates of 2514 ± 5 and 2478 ± 6 Ma, leading to the revised age ~2.5 Ga for the Kovdozero complex. It is thus considered to be coeval with Pados-Tundra, Perchatka, and gabbro–anorthosite associations of the Belomorian province in the White Sea region. The variation trends are generally extensive, continuous and close to linear at Kovdozero, which point to crystallization of chonolithic bodies of the complex from a single portion of melt, in separate reservoirs that likely communicated to develop as a whole in the connected system. The extreme degree of differentiation of derivatives of the initial komatiitic magma occurred in the large-scale plume. It led to the development of shallowly emplaced complexes grading from dunitic rocks and associated chromitites with Ru–Os–Ir mineralization at Pados-Tundra (the center) to leucocratic gabbroic rocks at Kovdozero, and likely to gabbro–anorthosite rocks of the Belomorian province (the periphery); these are considered the final products in the megastructure. The εNd(T) values are slightly negative at Kovdozero: −0.43 and −0.60. They imply some degree of crustal contamination of the initial magma. The generalized date of 2.5 Ga likely represents the age of the coronitic complexes of ultrabasic–basic rocks that crystallized from portions of komatiite-derived melts in hypabyssal settings of the LBB–SB megastructure in the eastern Fennoscandian Shield. Full article

Purpose: This study investigates receptor status changes following neoadjuvant chemotherapy (NAC) in breast cancer, aiming to identify new therapeutic opportunities and improve human epidermal growth factor receptor 2 (HER2) detection and categorization methods. Methods: This retrospective analysis was conducted on patients with breast cancer who underwent NAC and surgery between July 2022 and June 2024. Chi-square tests and logistic regression models were applied to assess the associations between HER2 status changes and clinicopathological features. Results: Among 508 patients, the receptor discordance rates after NAC were 5.3% for estrogen receptor (ER), 21.3% for progesterone receptor (PR), and 43.7% for HER2. Ki-67 expression decreased in 64.6% of cases and increased in 6.8%. Of the 103 patients with HER2-0, 47 (45.6%) transitioned to IHC 1+, 9 (8.7%) to IHC 2+/ISH−, and 1 (1.0%) to IHC 2+/ISH+. Among 256 patients with HER2 IHC 1+, 58 (22.7%) transitioned to IHC 2+/ISH−, 36 (14.1%) to IHC 0, and 9 (3.5%) to IHC 2+/ISH+. For 149 patients with HER2 IHC 2+/ISH−, 50 (33.6%) transitioned to IHC 1+, 6 (4.0%) to IHC 2+/ISH+, 5 (3.4%) to IHC 0, and 1 (0.7%) to IHC 3+. Univariate analysis revealed that, when compared to grade III tumors, grade I–II tumors exhibited a higher rate of HER2-0 to HER2-low conversion (66.7% vs. 36.8%, p = 0.027). HER2-low to HER2-0 conversion was associated with ER negativity (p = 0.028), PR negativity (p = 0.021), HER2 IHC 1+ (vs. IHC 2+, p = 0.001), and TIL >10% (p = 0.049). Multivariate analysis revealed that tumors with HER2 IHC 1+ were more likely to convert to HER2-0 after NAC than those with HER2 IHC 2+ (p = 0.020). Conclusions: Following NAC, ER gain, PR loss, and Ki-67 reduction were common. HER2 and ER status changes predominantly occurred within adjacent expression intensity levels. Full article

Background: Social media, especially Instagram, spreads nutrition-related information that often lacks scientific rigor. Many women report feeling inadequately informed about women’s health by healthcare professionals, turning to social media, increasing exposure to misinformation. Objectives: The NutriWomen platform aims to assess the quality, methodological soundness, and credibility of nutritional health claims and dietary recommendations on Instagram targeting women across different life stages. Its goal is to develop a systematic and scientifically grounded evaluation framework to assess Instagram nutrition-related claims and the methodological quality and interpretability of their supporting evidence, and to translate the results into accessible outputs that help women make informed nutrition decisions across life stages. Methods: This study follows a five-stage design Stage 1 involves a retrospective content analysis of Instagram posts containing nutrition-related claims targeted at women, identified through the “Top posts” function and screened using predefined criteria. Stage 2 assesses information quality using a validated 14-item tool. Stage 3 evaluates the scientific accuracy of claims by formulating PI(E)CO(TS) questions, selecting key outcomes, retrieving evidence from PubMed and the Cochrane Database, and appraising systematic reviews with a modified AMSTAR-2 tool incorporating GRADE ratings, when available. Stage 4 develops the NutriWomen website platform to translate assessments into accessible visual summaries. Stage 5 conducts a mixed-methods study with peri-, meno-, and postmenopausal women to explore information needs and evaluate platform usability through focus groups. Conclusions: The NutriWomen platform will be the first website to systematically publish the results of evaluations assessing the scientific quality of nutritional health claims on Instagram targeted at women across different life stages. It will provide a replicable methodology, and a digital tool designed to empower women with trustworthy nutrition information, with the potential to enhance health literacy and promote better health outcomes. Full article

Affordable high-frame-rate cameras and open-source software, such as Kinovea (ver. 2025.1.0), have expanded the potential for conducting kinematic assessments outside laboratory settings. This study examined the reliability and validity of Kinovea’s semi-automated linear kinematics tracking tool by comparing its outputs with those from a 3D marker-based motion capture system (Qualisys). Ten recreationally active male basketball players (x̄ ± SD: age 23.7 ± 1.7 years; height 183 ± 5 cm; body mass 76.8 ± 9.8 kg) performed three CMJ trials, simultaneously recorded using both systems. Reflective markers placed on the shoulder, hip, and knee were tracked in Kinovea by two raters with different levels of experience to extract core CMJ variables (total take-off time and maximum vertical displacement) and complementary variables (eccentric and propulsion duration, and minimum vertical displacement). Inter-rater reliability and concurrent validity were evaluated using intraclass correlation coefficients (ICCs), coefficients of variation (CV%), standard error of measurement (SEM), and Bland–Altman analysis. Results showed excellent inter-rater reliability (ICC = 0.73–0.99) across all markers, with the hip and knee demonstrating the highest consistency. Strong validity relative to Qualisys was observed for both raters (ICC = 0.68–0.99; r > 0.80), with small systematic biases primarily in temporal variables. Collectively, these findings demonstrate that Kinovea’s semi-automated 2D analysis yields reliable and valid CMJ measurements comparable to 3D motion capture, even for less experienced users. As a free and easily deployable tool, it offers a widely accessible alternative for field-based performance monitoring and applied biomechanics research where laboratory-grade equipment is not available. Full article

Background/Objectives: Knee osteoarthritis (KOA) is a multifactorial and degenerative disease. Growth differentiation factor 5 (GDF5) polymorphism rs143384 G > A is associated with reduced gene expression and musculoskeletal pathologies. This study aimed to evaluate the association between this functional polymorphism and clinical variability and disease severity among patients with KOA in an admixed population. Methods: This cross-sectional observational study enrolled 224 Brazilian patients with KOA, who were evaluated and classified according to disease severity. Results: The median age was 64 (44–84) years; 75.9% of the patients were female, 50.9% were shorter than 1.60 m, and 67.4% were obese or morbidly obese. The disease severity distribution was 64.7% grades I–III and 35.3% IV–V. Patients with KOA who were over 70 years had significantly more advanced grades (OR = 9.3; 95% CI = 3.4–26), in either female group (OR = 8.2; 95% CI = 2.6–26). The minor allele frequency of the GDF5 rs143384 A variant was 41.7% in the overall KOA case group, increasing with disease severity (39.7% in grades I–III versus 45.6% in IV–V). After adjusting for the confounding factors (age and BMI) the GDF5 GA + AA genotype was significantly associated with higher KOA severity IV–V in female patients (OR = 2.5; 95% CI = 1.2–5.3). Additionally, the mean height of female KOA patients with the GDF5 GA + AA genotype (1.56 ± 0.07 m) was significantly shorter than that of patients with the GG genotype (1.59 ± 0.08 m). Conclusions: The GDF5 rs143384 polymorphism was associated with greater KOA severity and shorter stature in female patients. These results suggest that this variant may contribute to phenotypic variability in patients with knee osteoarthritis, helping to refine clinical characterization and stratification in this population, contributing to personalized diagnoses and guiding future changes in treatment guidelines for knee osteoarthritis. Full article

Vertical shafts are the lifelines of coal mines, serving as critical conduits for resources and personnel. However, the long-term exposure of shaft walls to groundwater erosion significantly reduces their service life and increases the risk of structural failures. This issue is particularly pressing in Inner Mongolia and Henan Provinces, two of China’s major coal-producing regions, where the challenge of sulfate attack on shafts in deep stratigraphic environments has become a growing concern. This study focused on the corrosion damage observed in these two typical auxiliary shafts: the net diameters and depths of the auxiliary shafts in Shunhe Coal Mine and Mataihao Coal Mine are 6 m and 768.5 m and 9.2 m and 457 m, respectively. The rock section shaft walls in the study range from 5 to 10 m in thickness and are constructed using C40 to C60 grade concrete. To assess the extent of this damage, we conducted a comprehensive analysis of shaft wall samples using water analysis, XRD (X-ray diffraction) analysis, FT-IR (Fourier transform infrared) spectroscopy, and XRF (X-ray fluorescence) analysis. The findings reveal that the identified secondary sulfate reaction products within the shaft wall concrete include calcium sulfate, gypsum, ettringite, and thaumasite. The CaO loss rates in the auxiliary shaft walls of Shunhe Coal Mine and Mataihao Coal Mine are as high as 66% and 47%, respectively. Additionally, the concentrations of SO₃ and MgO in both mines exceed normal levels by up to 5 and 11 times, and 13 and 3 times, respectively. Despite this, severe corrosion is primarily confined to the inner surface of the auxiliary shaft walls, without significant penetration into the deeper shaft structure. The corrosion damage is predominantly concentrated in the shaft sections where the geological environment is characterized by bedrock. This study provides field evidence and laboratory analyses to inform the mitigation of sulfate attack in auxiliary shafts. Full article

Objective: Body awareness is the conscious, subjective multimodal integration of body-related sensitivity from bodily signals—detecting states and subtle reactions to internal and environmental conditions—modifiable by attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes, and affect. The aim of our study is to identify patient-reported outcome measures (PROMs) of BA and evaluate their psychometric properties and cross-cultural adaptation processes. Literature Survey: We searched PubMed, Scopus, and PsycINFO; the last search was conducted on 1 July 2025. Methodology: We included studies that psychometrically evaluated PROMs regarding BA in the general adult population and their translations into other languages, with no time-range restrictions. Study selection was performed independently by two reviewers in a blind manner. Evaluation followed COSMIN guidance for systematic reviews of PROMs: (1) risk of bias assessment, (2) application of quality criteria for measurement properties, and (3) GRADE rating of the certainty of evidence. Synthesis: We identified 12 BA questionnaires and more than 30 cross-cultural adaptations, from a total of 50 studies. In summary, the Revised Body Awareness Rating Questionnaire and the Multidimensional Assessment of Interoceptive Awareness (MAIA 1 and 2) showed good results for structural validity and internal consistency, which were the most frequently assessed psychometric properties. In contrast, construct validity was highly variable, and the findings on reliability were far from optimal. MAIA-2 was one of the most studied and showed stronger evidence and better pooled results (4 out of 5 properties) than other instruments. Conclusions: The psychometric quality of BA PROMs varies widely, reflecting challenges in operationalizing the construct of body awareness and related domains. While MAIA-2 currently presents the most acceptable—though still imperfect—evidence, further high-quality studies are needed to strengthen their measurement properties and clarify construct coverage. Full article

Background/Objectives: Some personalized alignment (PA) concepts have been described with symmetrical gaps in extension and flexion. However, laxity in native knees was significantly greater laterally than medially with respect to both extension and flexion. We hypothesized that a personalized alignment can restore the native knee alignment, keep a satisfying patellar tracking, and obtain physiological ligament balancing, that is, a symmetric gap in extension and an asymmetric gap in flexion. We aimed to assess: (1) the postoperative alignment of TKA and postoperative patellar tracking (primary outcome); (2) the ligament balancing at the end of the surgery; and (3) clinical outcomes and complication rates. Methods: In this single-center, retrospective case series, we evaluated 45 patients in a consecutive series who underwent robotic-assisted primary TKA using PA between January and September 2020 with a minimum follow-up of 5 years. Complication was defined as grade ≥3 according to the Clavien-Dindo classification. Data assessed were: TKA alignment and implant positioning on postoperative radiographs, patellar tracking on the merchant view, and ligament balancing in extension and flexion upon completion of surgery. Results: Mean follow-up was 62.1 ± 2.5 months. The postoperative mean HKA angle was 177.4° ± 2.2. The medial distal femoral angle was restored (91.1° ± 1.5 postoperatively versus 91.3° ± 2). A total of four TKAs had a patellar tilt superior to 5° (8.9%). No significant difference was found in the medial gap laxity—both in extension and in flexion—and the lateral gap laxity in extension. The lateral gap laxity in flexion was significantly higher than extension or medial gap laxity (+2.9 mm). One patient was readmitted for delayed wound healing. Average improvements in Knee Society knee and function scores were 55.86 and 51.84 points, respectively. Conclusions: This personalized alignment technique using anatomo-functional implant positioning allowed restoration of native knee alignment with a “safe zone” (3° varus/valgus) for the tibial implant, maintained satisfying patellar tracking, and restituted the asymmetrical gap laxity in flexion with a higher laxity in the lateral compartment. Being the longest system-specific study to date, the results are encouraging at 5 years with no major complications. However, longer follow-up will be required to confirm the use of this technique. Full article

Wheat possesses inherently low concentrations and bioavailability of the essential micronutrients (EMis) zinc (Zn), iron (Fe), manganese (Mn), and copper (Cu), limiting its capacity to sufficiently address human nutritional requirements. Biofortification of wheat with EMis through agricultural methods is a strategy aimed at addressing EMi deficiencies in human populations that emphasize cost-effectiveness and sustainability. All EMis are usually applied foliarly as sulfates, which indicates sulfur (S)-assisted biofortification. The formation of EMi complexes provides solubility as well as protection during long-distance transport. Several small molecules are possible candidates as ligands—the S-containing amino acids cysteine and methionine among them—linking EMi homeostasis to S homeostasis, which represents another aspect of S-assisted biofortification. In this study, we delve into the S-assisted agronomic biofortification strategy by applying sulfate micronutrients coupled with a sulfur-containing amino acid and we explore the effect of the selected accompanying cation (Zn, Fe, Mn, or Cu) on the EMi metallome of the grain, along with the biofortification effectiveness, whilst the type of the incorporated surface active agent seems to affect this approach. A field experiment was conducted for two years with durum wheat cultivation subjected to various interventions at the initiation of the dough stage, aiming to biofortify the grain with EMis provided as sulfate salts coupled with cysteine or methionine as potential biofortification enhancers. The mixtures were applied alone or in combination with commercial surfactants of the organosilicon ethoxylate (SiE) type or the alcohol ethoxylate (AE) type. The performance of two relevant preparations, FytoAmino-Bo (FABo) and Phillon, has been studied, too. The interventions affected the accumulation of the EMi metallome into the grains, along with the interactions of the EMis within this metallome. Several interventions increased the EMi metallome of the grain and affected the contribution of each EMi to this metallome. Many interventions have increased Zn and Fe, while they have decreased Mn and Cu. An increase in Zn corresponded (i) to a decrease in Cu, (ii) to an increase or no increase in Fe, and (iii) to a variable change in Mn. Cys increased the metallome by 34% and Zn and Fe within it. ZnSO₄ and FeSO₄ increased the metallome by 5% and 9%, whilst MnSO₄ and CuSO₄ increased the metallome by 36% and 33%, respectively. The additives improved the contribution to increasing the metallome in most cases. Without surfactant, the efficacy ranking proved to be MnSO₄ > CuSO₄ > ZnSO₄ > FeSO₄. The use of SW7 sustained the order CuSO₄ > MnSO₄ > ZnSO₄ > FeSO₄. The use of Saldo switched the order to CuSO₄ > ZnSO₄ > FeSO₄ > MnSO₄. In the case of Phillon, the order was CuSO₄ > FeSO₄ > ZnSO₄ > MnSO₄. The effect of Cys or Met was case-specific. The differentiations in the intensity of both the agronomic performance (grain weight, grain weight per spike, and yield) and the biofortification performance (concentrations vs. accumulations of each EMi within the grain) among the various combinations of EMis and additives are depicted by adopting a grading scale, which highlighted the intensity of the acclimation reaction of the biofortified grain to the applied intervention. Full article