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Embryology
The sixth edition of BRS Embryology includes improvements based on suggestions and
comments from the many medical students who have used this book in preparation for
the USMLE Step 1 examination and those students who have reviewed the book. I pay
close attention to these suggestions and comments in order to improve the quality of this
book. The goal of BRS Embryology is to provide an accurate and quick review of important
clinical aspects of embryology for the future physician. In addition, we have added color
to the diagrams. In this regard, I have used the following color scheme. The ectoderm/neuroectoderm
and derivatives are colored blue. The neural crest cells and derivatives are
colored purple. The mesoderm and derivatives are colored red. When multiple mesodermal
structures are involved (e.g., reproductive systems), I used light red and dark red. The
endoderm and derivatives are colored yellow.
Many times in the history of science, certain biological concepts become entrenched
and accepted as dogma even though recent evidence comes to light to challenge these concepts.
One of these concepts is the process of twinning. Recent evidence calls into question
the standard figures used in textbooks on how the process of twinning occurs. In particular,
it is becoming increasingly difficult to ignore the fact that dizygotic twins are sometimes
monochorionic. Although we by far do not know or attempt to explain exactly how twinning
occurs, it seems that the interesting cell and molecular events involved in twinning occur
in the first few cell divisions during first three or four days after fertilization. You are not a
twin because the inner cell mass splits. The inner cell mass splits because you are a twin.
I understand that BRS Embryology is a review book designed for a USMLE Step 1 review
and that you will not be faced with a question regarding this twinning concept, but I know
my readers are sophisticated enough to appreciate the scientific and clinical value of being
challenged to question traditional concepts as “grist for the mill” in discussions with your
colleagues.
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