Application of Nice knot technique in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures.@*METHODS@#A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated.@*RESULTS@#The wound area was 21.0-180.0 cm 2 (mean, 57.82 cm 2) before operation, and it was 1.2-27.0 cm 2 (mean, 6.57 cm 2) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days).@*CONCLUSION@#Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.

Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture / 中国修复重建外科杂志

OBJECTIVE@#To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures.@*METHODS@#A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up.@*RESULTS@#There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05).@*CONCLUSION@#Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.

Curative effects of Nice knot fixation on tuberosity healing in hemiarthroplasty for complex proximal humeral fractures / 中华创伤骨科杂志

Objective:To explore the curative effects of Nice knot fixation on tuberosity healing in hemiarthroplasty for complex proximal humeral fractures.Methods:A retrospective analysis was conducted of the eligible 32 complex proximal humeral fractures which had been treated at Department of Trauma and Orthopedics, Peking University People's Hospital between May 1, 2016 and May 1, 2019. Nice knot fixation was used to repair greater and lesser tuberosities in hemiarthroplasty for all the patients. There were 6 males and 26 females, aged from 60 to 90 years (mean, 74.9 years). By the Neer classification, there were 4 three-part fractures combined with dislocation, 20 four-part fractures, and 8 four-part fractures combined with dislocation. Shoulder joint X-rays were taken at postoperative 1, 2, 3, 6, and 12 months at the outpatient clinic to evaluate the patients' shoulder joint mobility, visual analog scale (VAS) pain score and Constant-Murley shoulder score. Tuberosity healing was assessed based on the X-rays and related complications were recorded.Results:The 32 patients received complete follow-up for 12 to 25 months (average, 17.82 months). At the 12-month follow-up, their shoulder flexion averaged 131.3° (from 80° to 155°), abduction 126.9° (from 80° to 155°), external rotation 48.4° (from 30° to 60°), internal rotation the L2 level, VAS pain score 0.9 (from 0 to 5), and Constant-Murley score 83.4 (from 58 to 96). The rate of patient satisfaction was 87.5%(28/32). Tuberosity-related complications were observed in 6 cases with an incidence of 18.8%. Complications like infection and prosthetic loosening were found in none of the patients.Conclusion:In hemiarthroplasty for complex proximal humeral fractures, application of Nice knot to fixate greater and lesser tuberosities can lead to rigid fixation, definite curative effects and a low incidence of tuberosity-related complications.

Clinical Practice Guidelines of Acupuncture for Low Back Pain : A Comparison of those of the UK and USA / 日本東洋医学雑誌

Low back pain (LBP) is one of the most common complaints of Japanese citizens, and is a symptom for which acupuncture has been applied since ancient times. We empirically recognize that acupuncture is effective for LBP, but in recent years, it became necessary to show evidence regarding its efficacy and effectiveness.Currently, to elucidate the effect of a medical intervention, randomized controlled trials (RCTs) are considered the gold standard and outcomes of RCTs are integrated as a systematic review (SR), and these are used to establish the degree of recommendation in the clinical practice guidelines (CPGs). Eventually, practitioners make their clinical decisions according to the recommendations in CPGs.In this report, the author compared CPGs of acupuncture for LBP between those of the United Kingdom (UK) and United States of America (USA). The NICE guideline development group of the UK did not fully understand Japanese-style acupuncture, and they considered clinical trials with placebo/sham as a control to be the most important, leading to underestimating the effect of acupuncture. On the other hand, the ACP guideline of the USA considers clinical trials with conventional treatment as a control to be more important, and accordingly the effect of acupuncture was evaluated realistically.

An audit of the decision to delivery interval in emergency caesarean section and its effect on neonatal outcome

Background: Emergency caesarean section (CS) is divided into four categories based on the degree of urgency by RCOG and NICE guidelines. It is recommended that the decision to delivery interval (DDI) in emergency CS should be within 30 minutes in category 1 and within 75 minutes in category 2. Our Primary objective was to study the incidence and indications of emergency CS and audit the DDI in emergency CS at tertiary care hospital. Our secondary objective was to study the effect of DDI on neonatal outcome.Methods: Descriptive study was carried out among 409 women who underwent emergency CS from August 2018 to December 2018 at St. John's medical college hospital, Bangalore. Relevant data was collected by chart review. Emergency CS were categorised according to RCOG guidelines based on the degree of urgency and further classified based on DDI as <30 minutes, 30-75 minutes and >75 minutes.Results: We had 409 cases of emergency CS. Category 1 had 113 (27.63%) cases, category 2 had 126 (30.81%) cases and category 3 had 170 (41.56%) cases. DDI of <30 minutes was achieved in 19.5% in category 1, DDI of <75 minutes was achieved in 93.65% in category 2. Fetal distress was the leading cause of emergency CS in category 1 and 2. There was a high incidence of low APGAR in babies delivered in <30 minutes and lower APGAR was significantly associated with <30 minutes of DDI (p<0.0001).Conclusions: Fetal distress was the leading cause of emergency CS. DDI interval of <30 minutes was not always associated with good neonatal outcome; Category of CS has a significant effect on neonatal outcome.

A Randomized Controlled Trial Comparing the Duration of Phototherapy Following NICE and AAP Guidelines in Neonatal Hyperbilirubinemia

Aims and Objectives: To compare duration of phototherapy between AAP and NICE guidelines in neonatal hyperbilirubinemia. Methods: In an open labelled study 130 babies with non-haemolytic hyperbilirubinemia were randomised to receive phototherapy following one guidelines between AAP and NICE. In this study we compared AAP 2004 and NICE 2010 guidelines to see whether following any of these two guidelines leads to phototherapy for longer duration. The primary outcome variable was duration of phototherapy and the secondary outcome variable was failure of phototherapy, defined as inability to reduce the TSB level of 2-3 mg/dl from baseline within 6 hours of phototherapy or inability to reduce TSB below exchange level. Results: Median age at onset of phototherapy was 77.55(19.43)hours in AAP group and 73.57(12.93) hours in NICE group, median gestational age was 37weeks in AAP group and 38weeks in NICE group, mean birth weight 2377.92gm in AAP group and 2457.10 gm. in NICE group, mean serum bilirubin at the onset of phototherapy was 18.77(1.570) mg/dl in AAP group and 18.24(1.89)g/dl in the NICE group. Average spectral irradiance was 55.8(µw/cm2/nm) in the study. Median duration of phototherapy in NICE as well as AAP group was 18 hours. There was no treatment failure in either group. Neurological examination was done at 40 weeks and 3 moths of corrected age. No abnormal neurological examination or BERA finding was reported in any of the babies. Conclusion: There is no difference in duration of phototherapy in any of the guidelines.

The including and recommendation of acupuncture in NGC and NICE / 中国针灸

The diseases recommended to be treated by acupuncture and the recommendation in the National Guideline Clearinghouse (NGC) and the National Institute for Health and Care Excellence (NICE) were summarized, and the diseases recommended were analyzed. The guidelines which mentioned acupuncture in NICE and NGC were searched and classified according to the types of diseases and intensity of recommendations. As a result, 45 guidelines in NGC were included, involving 59 recommendations; 29 guidelines in the NICE, involving 29 recommendations. The diseases recommended by NICE and NGC were mainly pain-related diseases, and the diseases recommended by NGC were wider. However, both needed to further describe the specific operation methods of acupuncture.

Major routes for orphan drugs to be incorporated into the reimbursement system of UK and the enlightenment to China / 中国药科大学学报

@#In order to provide enlightening experience for the establishment of reasonable and diversified orphan drugs into the reimbursement system in China, the official websites of the National Institute for Health and Care Excellence(NICE)and the National Health Service(NHS)in the UK were inspected, collecting and summarizing the relevant documents, on the inclusion of orphan drugs into the reimbursement system. Relevant literatures were analyzed with theoretical studies on the accessibility of medicines for patients with rare diseases. In the NHS system, the inclusion of orphan drugs into the reimbursement system in the UK can be achieved mainly through seven routes, with three routes that are evaluated by NICE(MTA, STA and HST)and four are directly managed by the NHS(specialized commissioning, CDF, IFRs, CtE). Through the analysis of the inclusion of orphan drugs into the reimbursement system and the various problems in the UK, we have found some enlightening experience for the establishment of the reimbursement system for orphan drugs in China.

Effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults / 中国修复重建外科杂志

Objective: To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Methods: Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. Results: The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). Conclusion: For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.

NICE classification in diagnosis and treatment of colorectal lesions / 中国内镜杂志

Objective To evaluate the efficacy of NICE classification in non-magnifying narrow band imaging for real-time histologic prediction and therapeutic guidance of colorectal lesions. Methods According to NICE classification, histologic prediction and therapeutic guidance were given for raised or flat raised colorectal mucosal lesions. According to pathology following biopsy, endoscopy or surgery, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification were valued. The observation consistency test was also carried out. Results 241 patients with 307 lesions were studied. The non-neoplastic lesions were 12.07%, adenomatous lesions were 82.07%, carcinomas were 5.86%. The lesions ranged from 0.1 cm to 6.0 cm in diameter. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification in differentiating non-neoplastic and neoplastic lesions were 97.04%, 89.19%, 96.09%, 98.50%, 80.49%. The Kappa of non-neoplastic and neoplastic lesions was 0.795. The Kappa of submucosal deep infiltrating lesions and lesions above superficial submucosa was 0.875. The total Kappa was 0.814. Conclusion NICE classification can accurately predict the histology of colorectal lesions and guide treatments. It is help to the moderate treatment mode in which merely neoplastic lesions are included in endoscopic resections or surgical procedures.

Comparison of the diagnostic accuracy of early screening for Preeclampsia by NICE guidelines, ACOG guidelines and comprehensive first trimester screening using maternal characteristics, ultrasonographic findings and maternal serum biochemical markers in the prediction of the development of Preeclampsia in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Introduction@#Preeclampsia remains to be a major cause of both fetal and maternal morbidity and mortality, particularly in severe forms leading to preterm birth. There is a lack of consensus, however, on the preferred screening test for early diagnosis with the aim of reducing the prevalence and morbidity of the disease. @*Objective@#To compare the performance of the comprehensive first trimester screening using maternal characteristics, ultrasonographic findings and serum biochemical markers, with the NICE and ACOG guidelines in predicting the development of preeclampsia. The study also aims to determine the compliance rate of clinicians in giving aspirin prophylaxis using the different screening tests. Methodology: This is a retrospective, analytical, cross sectional study of all pregnant patients between 11 to 13 6/7 weeks referred for comprehensive first trimester screening for preeclampsia from January 2014 to January 2018. Maternal factors were assessed to determine the risk of preeclampsia using NICE guidelines, ACOG guidelines and comprehensive first trimester screening. The compliance on aspirin administration for high-risk patients was also determined. The outcome measure was diagnosis of preeclampsia and the detection rate (DR) of the three screening tests were compared. @*Results@#A total of 202 women were included in the analysis where 24 (11.9%), 11 (5.4%) and 13 (6.4%) developed preeclampsia, early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) respectively. The NICE and ACOG guidelines were able to detect preeclampsia with an accuracy of 76.73% (Sn 75%, Sp 77% PPV 30.5%) and 43.07% (Sn 83.3%, Sp 37.6% PPV 15.3%) respectively. The comprehensive first trimester screening was able to detect preeclampsia with an accuracy of 89.60% (Sn 83.3%, Sp 90.5% PPV 54.1%). EO-PE and LO-PE were detected with an accuracy of up to 97.2% using the comprehensive screening (Sn 90.9%, Sp 97.9% PPV 71.4%), compared with the NICE guideline (up to 74.26%, Sn 81.8%, Sp 73.8% PPV 15.3%) and the ACOG guideline (up to 39.6%, Sn 90.9%, Sp 36.6, PPV 7.63%). Compliance with the NICE and ACOG recommendation on aspirin administration was only 42.37% and 33.33%, respectively, and this increased to up to 62% when comprehensive first trimester screening was used. @*Conclusion@#This study confirmed that the performance of screening for PE, and therefore appropriate selection of the patients that would benefit from prophylactic use of aspirin and closer surveillance, is by far superior if the comprehensive first trimester screening is used than the method advocated by ACOG and NICE.

The real-time diagnosis value of NICE classification on neoplastic and non-neoplastic colorectal polyps / 中华消化内镜杂志

Objective To investigate the value of NICE classification on real-time diagnosis for neoplastic and non-neoplastic colorectal polyps. Methods The histological type of 107 polypoid lesions from 50 patients detected by colonoscopy was predicted by 4 endoscopic physicians using NICE classification, including 1 chief physician, 2 associate chief physician, and 1 attending physician. Taking pathological result as gold standard, the real-time diagnostic accuracy of NICE classification for neoplastic colorectal polyps was evaluated, and the differences of diagnostic accuracy between the 4 endoscopic physicians were compared. Results Among the 107 polypoid lesions, 49 were neoplastic polyps and 58 were non-neoplastic polyps. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification on determination of the histological type of polyps were 81. 6% (40/49), 70. 0% (40/58), 74. 8% ( 80/107) , 70. 0%( 40/58) , and 81. 6%( 40/49) , respectively. There was no statistical difference on the prediction ability between the 4 physicians using NICE classification. Conclusion NICE classification is a feasible method for real-time prediction of histology type of colorectal polyps, and it is undemanding to the qualifications of physicians.

The real-time diagnosis value of NICE classification on neoplastic and non-neoplastic colorectal polyps / 中华消化内镜杂志

Objective To investigate the value of NICE classification on real-time diagnosis for neoplastic and non-neoplastic colorectal polyps. Methods The histological type of 107 polypoid lesions from 50 patients detected by colonoscopy was predicted by 4 endoscopic physicians using NICE classification, including 1 chief physician, 2 associate chief physician, and 1 attending physician. Taking pathological result as gold standard, the real-time diagnostic accuracy of NICE classification for neoplastic colorectal polyps was evaluated, and the differences of diagnostic accuracy between the 4 endoscopic physicians were compared. Results Among the 107 polypoid lesions, 49 were neoplastic polyps and 58 were non-neoplastic polyps. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of NICE classification on determination of the histological type of polyps were 81. 6% (40/49), 70. 0% (40/58), 74. 8% ( 80/107) , 70. 0%( 40/58) , and 81. 6%( 40/49) , respectively. There was no statistical difference on the prediction ability between the 4 physicians using NICE classification. Conclusion NICE classification is a feasible method for real-time prediction of histology type of colorectal polyps, and it is undemanding to the qualifications of physicians.

Comparative analysis and interpretation of NCCN, NICE and ESMO guidelines for colorectal cancer / 中国癌症杂志

It is important for patients with colorectal cancer to receive standard and reasonable treatment. There are many clinical practice guidelines for diagnosis and treatment of colorectal cancer. However, the most influential guidelines are NCCN, ESMO and NICE guidelines. NCCN guidelines are the most world-renowned guidelines from National Comprehensive Cancer Network of the United States; ESMO guidelines are promulgated by the European Society for Medical Oncology; NICE guidelines are guidance of diagnosis and management for colorectal cancer issued by the National Institute for Health and Care Excellence of the United Kingdom. They are very similar in case management and treatment principles. However, there are still some differences in indications for drugs, treatment of hereditary colorectal cancer, laparoscopy indication and management of ileus. Here we discuss some of these differences and provide a reference for standardization of colorectal cancer treatment in China.

Experience from translation mechanisms in the NICE health technology assessment to NHS de-cision making / 中国卫生政策研究

The National Institute for Health and Care Excellence ( NICE) is taken for the typical success in u-sing health technology assessment to control cost increase. For other countries in a budget constrained context, this health technology assessment process and knowledge translation mechanism might be of significant implications. The objective of this paper is to provide some hints of knowledge translation to evidence-based decision making by sharing the experience from the NICE health technology assessment.

Efficacy of NICE classification under narrow-band imaging in real-time diagnosis of colorectal polyps / 中华消化内镜杂志

Objective To evaluate the diagnostic efficacy of non-magnified NBI in distinguishing neoplastic from non-neoplastic colorectal polyps,using a simple classification system(NBI international colo-rectal endoscopic[NICE]classification).Methods A total of 181 lesions detected by white light colonosco-py were enrolled in this prospective study.Each lesion was assessed by NBI,and the histology was predicted according to characteristics of lesion color,microvascular architecture,and surface pattern.The results were compared with actual histologic findings.Results The diagnostic sensitivity,specificity,PPV,NPV,and accuracy of NBI were 95. 8%(114/119),91. 9%(57/62),95. 8%(114/119),91. 9%(57/62),and 94. 5%(171/181),respectively.Diagnostic accuracy was 90. 0%(72/80)in the 1 to 5 mm group,95. 9%(47/49)in the 6 to 9 mm group,98. 1%(51/52)in the more than 10 mm group,with no statistically sig-nificant differences(P=0. 175).The sensitivity,specificity,PPV,NPV,and accuracy of NBI for diminu-tive rectosigmoid neoplasms were 87. 5%(14/16),95. 2%(20/21),93. 3%(14/15),90. 9%(20/22), and 91. 9%(34/37).Conclusion NICE classification with non-magnified NBI is effective in distinguishing neoplastic from non-neoplastic colorectal lesions.

Ronda clínica y epidemiológica / Clinical and epidemiological round

Las guías de prácticas clínica han mejorado en calidad durante los últimos 10 años gracias al cumplimiento de algunos principios básicos, como por ejemplo, la revisión sistemática que se hace de la información importante, la valoración de la calidad de los estudios en los cuales están basadas las recomendaciones y el establecimiento de una jerarquía en las recomendaciones clínicas que se emiten.

Food-Grade Nisin Controlled Gene Expression System NICE of Lactic Acid Bacteria / 中国生物工程杂志

Lactic acid bacteria (LAB) are traditional dairy strains which have a long history of safe use. They are a kind of food-grade microorganisms that can be used in industry to produce lots of food and drink, such as yoghourt. In the last two decades the physiology and genetics of these bacteria have been thoroughly studied. Because of their genetic accessibility and easy to handle, LAB, in addition to their traditional applications, have been extensively developed and used for the expression of heterologous genes. So they have an important foreground in agricultural, medical and many other fields. People have developed a series of food-grade gene expression systems of LAB. LAB, especially their model strain Lactococcus lactis and their most useful food-grade induced expression system--nisin controlled gene expression system NICE and its food-grade inducer nisin, food-grade host, expressing vectors and applications in expressing heterologous proteins of NICE will be introduced.