center randomized clinical trial has demonstrated the efficacy of intravenous gamma globulin in preventing these aneurysms. Scientists now recommend that gamma globulin therapy be introduced as soon as possible after diagnosis. The Institute will continue to support research on this disease to determine its cause and to develop a sensitive and specific diagnostic test to identify children who may have the disease, but do not have the obvious symptoms, so early treatment may be initiated. Neonatal respiratory distress syndrome A significant finding from recent research is that respiratory distress syndrome in premature infants can be treated with human lung surfactant. In addition, the recent isolation of the genes for three surfactant proteins will allow for future studies of the genes responsible for making surfactant proteins, for studying gene expression during lung development, and for production of human surfactant for possible clinical use. Blood resources The Institute is working with major professional and voluntary organizations to design a national education program to allay unfounded fears regarding AIDS and blood transfusion or donation; to promote autologous (self-directed) blood donation and establish eligibility criteria for autologous donation; and to develop networks for consultation with transfusion medicine experts. Sickle cell disease In a recent clinical trial for treatment of infants with sickle cell disease, investigators demonstrated that daily administration of oral penicillin can reduce the high incidence of septicemia caused by Streptococcus pneumoniae, which frequently causes death in these children. Because the group treated with penicillin had no deaths from pneumococcal infection, the trial was terminated 8 months early. These findings support the possibility of preventing the 150 to 180 deaths that occur each year in the United States among sickle cell disease infants who contract the infection. A recently initiated clinical trial will evaluate the long-term effects of this treatment strategy. Cystic fibrosis Cystic fibrosis is the most common lethal genetic disease in the Western World. Scientists have now localized the gene for this disease on the seventh chromosome, and believe they have identified the sequence of molecules of the the cystic fibrosis gene. Markers have also been identified to establish the presence of the gene in members of families in which a child already has the disease. Investigators are now using the markers to predict whether an expected child is likely to have the disease if a couple already has a child with cystic fibrosis. Progress in managing the pulmonary complications of cystic fibrosis patients is resulting in greater longevity and better quality of life. The success of existing centers and other research programs supported by the Cystic Fibrosis Foundation has proven the vitality of the mul tidisciplinary approach such centers can bring to the problems that surround cystic fibrosis. In view of the medical burden caused by cystic fibrosis and the recent encouraging research progress, the Committee has provided up to $3,000,000 to fund cystic fibrosis research centers selected through the normal competitive process. $2,500,000 of this total has been provided within the budget for the National Institute of Diabetes and Digestive and Kidney Diseases. Regression of arteriosclerosis Arteriosclerosis, or hardening of arteries, is a major cause of heart attacks, strokes, and occlusive disease of the peripheral vessels. A multiyear, extensive research study demonstrated that a modest reduction in plasma cholesterol concentrations is able to produce regression of atherosclerotic plaque in Rhesus monkeys. Since research on the possible regression of atherosclerosis through dietary intervention has considerable significance, additional clarifying studies are being conducted. Prevention, behavioral medicine, and nursing The Committee is pleased with the efforts of the NHLBI to actively involve leaders of the nursing profession in its programs. The Committee has also been impressed with the continuing emphasis on prevention and behavioral medicine activities and urges that these continue to receive a high priority. Sleep disorders The Committee is impressed with the unified support for development of a Specialized Center of Research [SCOR] Program in cardiopulmonary disease of sleep. The center will stimulate a multidisciplinary approach to integrate basic research as it relates to sleep and the heart and lungs and define recognizable clinical cardiopulmonary disorders of sleep. The Committee, therefore, recommends development of this program at NHLBI, and has provided the appropriate centers allotment and funding. This does not include $3,310,000 provided for AIDS in another section. The Committee recommends an appropriation of $131,559,000 for the National Institute of Dental Research [NIDR]. This is $22,983,000 more than the administration request, $13,503,000 more than the fiscal year 1987 appropriation of $118,056,000, and $2,594,000 more than the House allowance. The NIDR conducts and supports research and research training on oral hard and soft tissues. Specific research areas include dental caries; periodontal diseases; birth defects affecting the face, teeth, and bones; oral cancer; infectious diseases such as herpes and AIDS; chronic pain; biomaterials, such as bonding substances; behavioral studies; nutrition; epidemiology; and basic studies of oral tissue development, repair and regeneration. Caries and periodontal diseases NIDR nationwide surveys have indicated major declines in dental caries in children and an overall improvement in the oral health of adults. For example, one third of youngsters between the ages of 5 and 17 have no tooth decay according to a 1979-80 survey, while the prevalence in the remaining children was approximately one-half that seen in children a generation ago. NIDR attributes these improvements to water fluoridation and use of fluoride in other forms. Dental health of older Americans The Committee notes that the NIDR national survey of the oral health of employed adults and seniors conducted in 1986-87 points to a clear need to enhance research to improve the oral health of older Americans. Forty-two percent of men and women 65 and over examined in the survey have lost all of their teeth-compared to only 4 percent of adults between 18 and 65. Those who have retained their teeth continue to experience tooth decay-especially on the roots of teeth which become exposed because of gum recession. Older Americans also suffer extensive and severe periodontal disease, the major cause of tooth loss in adults. Faced with the pressing need to help older Americans maintain healthy teeth and gums, and prevent needless pain, suffering, and expense, the Institute has expanded initiatives in all aspects of oral health research in aging, drawing upon its intramural researchers as well as grantees to address key issues. The Committee has been informed that one major initiative is a collaborative project with the National Institute on Aging and the Veterans Administration involving cofunding and in-kind support of oral health in aging research and training centers. The research focus of these individual centers could include such areas as epidemiologic studies, pain research, nutrition in relation to aging and disease prevention initiatives. While commending this new center research effort, the Committee urges the NIDR also to undertake a more specific initiative to improve the oral health status of the current seniors and to insure that future generations of older Americans never again experience the oral health problems of past generations. Indeed, the Committee recommends the NIDR set as its target the elimination of edentulousness (loss of teeth) in the United States. The NIDR should undertake this oral health promotion and disease prevention demonstration and research effort utilizing the contract as well as grant and intramural program mechanisms. Additionally, the Committee directs that planning be initiated for three geriatric oral health centers for clinical trials, training and other research activities and that such centers be opened at the earliest possible date. To help initiate this long-term effort to improve the oral health of older Americans, the Committee recommends $500,000 of support for fiscal year 1988. Research directions The NIDR is using its survey results to establish baseline measurements of oral health and to guide future research efforts. Another children's survey is under way to determine if caries rates are still declining and to identify children at high risk for caries by analyzing saliva samples for decay-causing bacteria. Devices for the controlled release of fluoride can be implanted in the mouths of susceptible individuals to prevent decay. Severe forms of periodontal disease occur in young people, as well as in diabetic patients and individuals with rare genetic syndromes. Clinical studies of these patients are revealing immune system defects and, in some cases, implicating bacteria that have been infected with a virus. Other researchers have been exploring treatments to save teeth made loose because periodontal disease has partially destroyed the fibers and bone that anchor the tooth in the jaw. One of these treatments involves controlling the cell type allowed to migrate to the tooth root so that daughter cells can develop into bone- and ligament-forming cells to reanchor the tooth. AIDS NIDR imunologists are studying monocytes, immune cells that are infected but not killed by the human immunodeficiency virus [HIV], to determine how the virus undermines immune capacity and what role these cells may play in spreading the virus in the body. Researchers studying the salivary glands of AIDS-infected patients in good health have found that there may be specific changes in salivary components that appear early in the course of infection. If confirmed, these signs may be important diagnostic markers and may lead to new treatments. Other NIDR researchers are using a newly developed test for the invasiveness of cancer cells to study Kaposi's sarcoma cells and to evaluate new antimetastatic drugs. Thematic centers The Committee recognizes that an important tactic in the Institute's strategy for solving oral health problems has been the establishment of centers to focus research efforts on specific disorders, such as periodontal disease and tooth decay. Moreover, we are aware that the first of these thematic centers, established for periodontal disease, has already identified micro-organisms which will help in understanding how to prevent this disease. It appears to the Committee that these thematic centers fill a major gap in the Institute's dental research program and, as such, additional funds have been provided to begin planning to increase the number of centers being supported from the current 16 to up to 21; including new centers for oral health in the aged and for restorative materials, as well as CORE grants. In view of the special dental health problems of the elderly, the Committee directs that at least two of the new thematic centers focus on geriatric dental issues. The Committee urges that such centers be funded at the earliest date possible. Research manpower The Committee has for the past 3 years provided funding for 25 new dental scientist candidates with the goal of admitting 25 new candidates a year until 25 are graduated each year. The objective of the program is to facilitate the movement of research from basic to clinical application by increasing the pool of investigators who combine research knowledge and skills with the expertise of the dental practitioners. For fiscal year 1988, the fourth year of the plan, the Committee has provided $1,895,000 over the President's budget for the dentist-scientist program, in order to permit the Institute to fund an additional 25 awards. 1 This does not include $3,500,000 provided for AIDS in another section. The Committee recommends an appropriation of $549,784,000 for the National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK]. This is $105,780,000 more than the administration request, $38,354,000 more than the fiscal year 1987 appropriation of $511,430,000, and $13,984,000 less than the House allowance. The NIDDK conducts and supports research and research training in diabetes, endocrinology, and metabolic diseases; digestive diseases and nutrition; and kidney, urologic, and blood diseases. The Committee was pleased to learn that a Committee established by NIH has recommended that all of the programs currently existing within the Institute should remain there. In particular, the Hematology Program, which has a significant role to play in basic research in this Institute, was considered to be a major integral element of the Institute, and hematological research appropriately should continue to be supported in the Institute. Digestive diseases Digestive diseases are a leading cause of disability and cost billions of dollars annually in medical care and lost wages. However, several areas of research point toward promising results. For example, recent studies have led to significant progress in treating peptic ulcers. The role of brain-gut peptides in causing digestive diseases is another promising research area now under intense investigation. To reduce the incidence and cost of treating gallstones, the Institute has launched a multifaceted inquiry into the causes of and treatments for gallstones and has participated in an extensive epidemiologic study. In one project, a method to dissolve gallstones with a gas has been developed. This treatment could reduce the risks of surgery and some of the $2,500,000,000 annual cost of treating gallstones. Resources for the study of liver diseases are being augmented by the founding of a liver transplantation data base and a network for liver tissue collection. Intramural researchers are successfully treating hepa |