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"Conjoined twins"
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BZRK reloaded
The struggle for control between the Armstrong twins and the group known as BZRK continues with the stakes higher than ever.
Book
Most Unusual Twin Pairs: A Look at Uterus Didelphys / Twin Research Reviews: Prenatal Aneuploidy Screening for Twin Pregnancies; Twin Conceptions by Same-Sex Male Couples; Legal Personality of Conjoined Twins; Twin Study of Cannabis Use / Human Interest and Importance: Being Taken for Twins Saved Sisters; Twin Children of Jailed Nobel Prize Winner; British ‘Biracial’ Twins; Triplets Born at Start of Russian Attack on Ukraine; Twins Born in Different Years
A review of an unusual twin type—twins born to women with two uteri (uterus didelphys)—is presented. This review is followed by summaries of recent research and perspectives concerning prenatal aneuploidy screening for twin pregnancies, twin conceptions by same-sex male couples, legal personality of conjoined twins, and a twin study of cannabis use. Interesting information about twins that has appeared in the media is also presented, namely how being taken for twins saved a pair of sisters; twin children of a jailed Nobel Prize winner, British ‘biracial’ twins, triplets born at the start of Russia’s attack on Ukraine, and twins born in different years.
Journal Article
BZRK
In the near future, the conjoined Armstrong twins, under the guise of the Armstrong Fancy Gifts Corporation, plot to create their own version of utopia using nanobots, while a guerilla group known as BZRK develops a DNA-based biot that can stop bots, but at risk of the host's brain.
Book
Separation of conjoined spinal cords in symmetrical pygopagus twins using intraoperative neuromonitoring: pearls and pitfalls
Pygopagus twin is a rare congenital malformation with a worldwide incidence of 1in 200,000. Few literature reports are published regarding the matter. In some cases, neuromonitoring is essential for safe surgical separation. We believe it is important to share our challenges and nuances in order to minimize obstacles one might encounter. We utilized neuromonitoring during our separation of both twins, and we planned a multidisciplinary approach and efficient communication system with the other teams in order to plan a successful, safe, and timely separation of the twins. We seek to highlight not our success but rather the obstacles and challenges we encountered during the separation of pygopagus twins in our institute using neuromonitoring for future reference.
Journal Article
Parasitic pygopagus conjoined twins’ incidental findings in the obstructed labor of an intrapartum dead baby that had undergone emergency C-section: rare case report in South Papua
Background
Conjoined twins (CT), which used to be historically defined as “monstrous human” and previously so-called Siamese twins in the early eighteenth century, are one of the very rare congenital malformations with an uncertain etiology and complex yet remain inconclusively debatable regarding its pathophysiological mechanisms of fusion and fission theories. Among all types of CT, parasitic CT, especially the pygopagus sub-type, is exceedingly rarer. To the best of the authors’ knowledge, no parasitic CT had been reported in Papua, and this is the first finding in South Papua.
Case Report
Herein, a 30-year-old multigravida female with 37th-week gestation, previous twice spontaneous miscarriage, and non-adequate antenatal care history is presented with a chief complaint of painful construction and greenish fluid leakage from the vagina, with an examination that showed a cephalic presentation with a “peculiar” big mass at the upper uterus and complete cervical dilation toward second-stage inpartu. Vaginal delivery was performed with a complication of obstructed labor due to uncommon dystocia with a suspected “big mass” below the fetal buttocks and intrapartum dead. Intrapartum transabdominal ultrasound demonstrates a gross anatomically like an organ inside a fluid-filled mass with unidentified parts, leading to a suspected type of congenital malformation at the baby’s sacral region. Emergency C-section was done with findings of parasitic pygopagus CT, showing an attachment of a large irregular fluid-filled mass-like incomplete twin (parasite) with palpable soft tissue and bony structure inside to the buttocks of a male autosite twin, and an additional third leg which happened to be an under-developed lower extremity with a sacrum-like structure.
Conclusions
An obstetrician’s routine ANC and critical radiological evaluation will increase the odds of identifying CT or other congenital malformations to provide better delivery planning or further management. Increasing maternal health knowledge in society, improving medical skills and knowledge levels for health providers, and advancing supporting facilities and specialists are future strategies for managing and preventing such cases in low-middle-income countries.
Journal Article
Gemini : a novel
In a small town, as high school graduation approaches, two conjoined sisters must weigh the importance of their dreams as individuals against the risk inherent in the surgery that has the potential to separate them forever.
BOOK
Few-shot learning using explainable Siamese twin network for the automated classification of blood cells
Automated classification of blood cells from microscopic images is an interesting research area owing to advancements of efficient neural network models. The existing deep learning methods rely on large data for network training and generating such large data could be time-consuming. Further, explainability is required via class activation mapping for better understanding of the model predictions. Therefore, we developed a Siamese twin network (STN) model based on contrastive learning that trains on relatively few images for the classification of healthy peripheral blood cells using EfficientNet-B3 as the base model. Hence, in this study, a total of 17,092 publicly accessible cell histology images were analyzed from which 6% were used for STN training, 6% for few-shot validation, and the rest 88% for few-shot testing. The proposed architecture demonstrates percent accuracies of 97.00, 98.78, 94.59, 95.70, 98.86, 97.09, 99.71, and 96.30 during 8-way 5-shot testing for the classification of basophils, eosinophils, immature granulocytes, erythroblasts, lymphocytes, monocytes, platelets, and neutrophils, respectively. Further, we propose a novel class activation mapping scheme that highlights the important regions in the test image for the STN model interpretability. Overall, the proposed framework could be used for a fully automated self-exploratory classification of healthy peripheral blood cells. The whole proposed framework demonstrates the Siamese twin network training and 8-way k-shot testing. The values indicate the amount of dissimilarity.
Journal Article
Individualized intervention and growth dynamics assessment in TRAP sequence with conjoined twins based on radiofrequency ablation
Background
Twin reversed arterial perfusion (TRAP) sequence with conjoined twins (CTs) represents an exceedingly rare and critical complication in monochorionic monoamniotic (MCMA) twin pregnancies. High mortality rates are associated with this condition, making early diagnosis and management crucial for improving survival outcomes, particularly for the pump twin.
Case presentation
This case report focuses on a unique instance of TRAP-associated CTs, diagnosed at 13 weeks and 1 day of gestation. Management involved detailed ultrasonography and radiofrequency ablation (RFA) at 18 weeks and 5 days to interrupt the blood supply to the non-viable acardiac twin. This intervention allowed the pump twin to continue normal development, culminating in a cesarean delivery at 35 weeks and 1 day. The newborn showed a healthy postnatal outcome with no significant neurodevelopmental deficits noted at follow-up.
Conclusions
Early identification and tailored intervention are essential in cases of TRAP sequence associated with conjoined twins. This case exemplifies the potential of integrated multidisciplinary approaches and timely use of RFA, which significantly enhance the prognosis for the viable twin. These strategies are vital for managing complex MCMA pregnancies and can inform future clinical practices.
Graphical abstract
Journal Article