When active bone marrow release is induced by inflammatory stimuli, it is associated with an increase in L-selectin expression on circulating polymorphonuclear leukocyte (PMN). This contrasts sharply with glucocorticoid-induced granulocytosis that is associated with decreased L-selectin expression on PMN. The present study was designed to determine if the reduced L-selectin expression observed after glucocorticoid treatment is the result of suppression of L-selectin synthesis in the bone marrow. New Zealand white rabbits treated with dexamethasone (2.0 mg/kg, a single dose intravenously) were shown to have decreased L-selectin expression on circulating PMN 12 to 24 hours after treatment (P < .01) with a return to baseline levels by 48 hours. When dexamethasone was administered 48 hours after the bone marrow PMN were pulse labeled with the thymidine analogue, 5′-bromo-2′-deoxyuridine (BrdU), L-selectin expression on BrdU-labeled PMN released from the bone marrow was decreased (P< .01). Dexamethasone decreased L-selectin expression on segmented PMN in the bone marrow (P < .05) but not on PMN already in the circulation. We conclude that glucocorticoids decrease L-selectin expression on circulating PMN by downregulating L-selectin expression in the maturation pool of bone marrow and speculate that this is an important glucocorticoid effect that influences the recruitment of PMN into inflammatory sites.

We assessed the effectiveness of two methods of patient education, a printed manual and a Website, provided to patients waiting for cardiac surgery. The four-phase study was conducted over two and a half years, and included urban and rural subjects in Vancouver and the interior of British Columbia. The Website was based on the specially developed patient education manual. A pilot evaluation study was carried out to assess the features of the Website and to ensure it was 'user-friendly', after which it was revised. The two education methods were evaluated using both qualitative and quantitative studies. Findings supported the feasibility and viability of both formats. The Web-based format demonstrated two additional benefits over the print-based format, namely increased social support and decreased anxiety. Other findings included the perception of increased support, lifestyle changes and more positive attitudes towards the impending surgery.