Background: Preoperative treatments are considered for patients with worse outcome to improve overall survival and reduce tumor relapse. This study developed a prognostic risk estimation for patients with hepatitis B virus (HBV)-related solitary hepatocellular carcinoma after curative resection, including preoperative computed tomography (CT) signatures. Methods: Preoperative multiphasic CTs for 166 patients with operable HCC were performed in our hospital from 15 November 2013 through 15 May 2015. Follow-up information, until 5 June 2017, included: CT, pathological and clinical characteristics, and recurrence and metastases of HCC confirmed by pathological or radiological diagnosis. The parameters were analyzed by the Kaplan-Meier method and Cox proportional hazards regression analysis. Results: In multivariate analyses, overall survival was not significantly associated with any of the analyzed prognostic risk factors, but did show that the following were significant prognostic risk factors for disease-free survival: larger tumor size, positive radiogenomic venous invasion, non-smooth tumor margin, and histological microvascular invasion. These were all incorporated into the nomogram. The calibration curves for predicting the probability of disease-free survival between the nomogram and actual observation showed good conformity. Conclusion: In patients with HBV-related HCC, CT signatures were a noninvasive significant indicator of disease-free survival. Thus, consideration of CT signatures may optimize preoperative treatment strategies for the individual patient.

This study aimed to explore the effect of long non-coding RNA (LncRNA) H19 on the proliferation and invasion of lung carcinoma cells A549, and to determine its molecular targets.

We describe the mobilome of Escherichia fergusonii 40A isolated from poultry, consisting of four different plasmids, p46_40A (IncX1, 45,869 bp), p80_40A (non-typable, 79,635 bp), p150_40A (IncI1-ST1, 148,340 bp) and p280_40A (IncHI2A-ST2, 279,537 bp). The mobilome-40A carries a blend of several different resistance and virulence genes, heavy metal tolerance operons and conjugation system. This mobilome 40A is a perfect tool to preserve and disseminate antimicrobial resistance and makes the bacterial isolate incredibly adapted to survive under constant antimicrobial pressure.

Purpose: Treatment-refractory Giardia cases have increased rapidly within the last decade. No markers of resistance nor a standardized susceptibility test have been established yet, but several enzymes and their pathways have been associated with metronidazole (MTZ) resistant Giardia. Very limited data are available regarding genetic variation in these pathways. We aimed to investigate genetic variation in metabolic pathway genes proposed to be involved in MTZ resistance in recently acquired, cultured clinical isolates. Methods: Whole genome sequencing of 12 assemblage A2 and 8 assemblage B isolates was done, to decipher genomic variation in Giardia. Twenty-nine genes were identified in a literature search and investigated for their single nucleotide variants (SNVs) in the coding/non-coding regions of the genes, either as amino acid changing (non-synonymous SNVs) or non-changing SNVs (synonymous). Results: In Giardia assemblage B, several genes involved in MTZ activation or oxidative stress management were found to have higher numbers of non-synonymous SNVs (thioredoxin peroxidase, nitroreductase 1, ferredoxin 2, NADH oxidase, nitroreductase 2, alcohol dehydrogenase, ferredoxin 4 and ferredoxin 1) than the average variation. For Giardia assemblage A2, the highest genetic variability was found in the ferredoxin 2, ferredoxin 6 and in nicotinamide adenine dinucleotide phosphate (NADPH) oxidoreductase putative genes. SNVs found in the ferredoxins and nitroreductases were analyzed further by alignment and homology modeling. SNVs close to the iron-sulfur cluster binding sites in nitroreductase-1 and 2 and ferredoxin 2 and 4 could potentially affect protein function. Flavohemoprotein seems to be a variable-copy gene, due to higher, but variable coverage compared to other genes investigated. Conclusion: In clinical Giardia isolates, genetic variability is common in important genes in the MTZ metabolizing pathway and in the management of oxidative and nitrosative stress and includes high numbers of non-synonymous SNVs. Some of the identified amino acid changes could potentially affect the respective proteins important in the MTZ metabolism.

Objective: This study aims to evaluate the expression pattern of circulating microRNAs (miR)-486-5p, miR-497, miR-509-5p, and miR-605 in the serum of metabolic syndrome (MetS) Egyptian male patients. Methods: In this study, the circulating miR-486-5p, miR-497, miR509-5p, and miR-605 were amplified and quantitatively detected by quantitative real-time polymerase chain reaction in sera of 55 MetS male patients in comparison to 20 male controls. The level of fasting plasma glucose and triacylglycerol (TAG) were measured using calorimetric assay. Blood pressure was measured using mercuric sphygmomanometer. Anthropometric measurements were done to each individual. Furthermore, MetS patients were defined according to the criteria proposed by the American Heart Association and divided into three groups according to MetS index. Results: The study was performed on three groups and a control group defined as follows: group 1: 15 MetS patients who fulfilled all diagnostic criteria of MetS; group 2: 20 MetS patients with normal blood pressure; group 3: 20 MetS patients with normal TAG levels.The levels of miRs are expressed as [median (IQR)]. miR-486-5-p and miR-497 expression were elevated in group 1 [31.9(49), p˂0.0001; 73.1(42.5), p˂0.0001], group 2 [36.4(15.7), p˂0.0001; 68.3(54.8), p˂0.0001], and group (3) [10.8(18.9), p=0.0014; 27.5(39.7), p=0.0012]. MiR-509-5p was elevated in groups 1 and 2 [501(468), p=0.0001], [309(436), p=0.0006], respectively, while normally expressed in group 3 [0.93(0.077), p=0.0001]. miR-605 was elevated in groups 1 and 3 [25.4(20.0), p=0.0018], [54.8(65.8), p˂0.0001], while normally expressed in group 2 [0.84(0.67), p˂0.0001]. Conclusion: miRs (486-5p, 497, 509-5p, and 605) serum levels were higher in MetS patients than in healthy control subjects; therefore, these serum miRs can serve as early biomarkers and can be used to follow-up the prognosis of MetS.

Purpose: We aimed to examine the possible association role of vitamin D and vitamin D receptor (VDR) single nucleotide polymorphisms (SNPs) in type 1 diabetes mellitus (T1DM) development, glycemic control and complications among a cohort of Egyptian children. Subjects and methods: A prospective case-control study has been conducted on 50 Egyptian children with T1DM who were comparable with 50 controls. Vitamin D and HbA1c were measured. VDR-SNPs [ApaI (rs7975232), TaqI (rs731236) and BsmI (rs1544410)] detection was done by polymerase chain reaction through restriction fragment length polymorphism (PCR-RFLP) technique. Vitamin D supplements were given to the included T1DM children with low vitamin D and reassessments of both HbA1c% and 25(OH)D serum levels were performed in those children three months later. Results: Eighty percent of the included diabetic patients have poor glycemic control. Vitamin D was deficient in 68% and insufficient in 16% of diabetic patients. Significant improvements in both vitamin D and glycemic status among T1DM children, who have low vitamin D and received vitamin D supplementations. There were significantly negative correlations between serum levels of vitamin D with both HbA1c % (r= -0.358, P˂0.05) and daily insulin dose (r=-0.473, P˂0.05). Compared with controls, T1DM children presented more commonly with ApaI a allele (OR: 2.87; 95%CI: 1.39-5.91, P˂0.05) and BsmI b allele (OR: 4.38; 95%CI: 2.30-8.33, P˂0.05). TaqI t allele wasn't significantly differing among patients and controls (P˃0.05). Aa+aa and Bb+bb genotypes were significantly higher among T1DM vs the controls (OR: 3.08;, 95%CI: 1.33-7.15, P˂0.05 and OR: 9.33; 95%CI: 3.61-24.17, P˂0.05respectively). Conclusion: ApaI and BsmI were associated with risk of T1DM development among Egyptian children. Low vitamin D status was frequently occurring among T1DM with significant improvement in the glycemic control of such children when adding vitamin D supplements to the standard insulin therapy.

Introduction and aim: New onset diabetes after transplantation (NODAT) is a serious metabolic complication following kidney transplantation. Although beta-cell dysfunction is considered the main contributing factor in the development of this complication, its exact etiology is yet to be identified. We aimed to investigate NODAT among kidney transplant cohort in Kuwait with special stress on correlation between its risk factors and interferon gamma genotyping. Materials and methods: We surveyed 309 kidney transplant recipients from Hamed Al Essa Transplantation Centre, Kuwait. The participants were categorized into cohorts according to the development of NODAT diagnosed based on the American Diabetes Association guidelines. Statistical analyses were performed using SPSS software. We genotyped interferon gamma as the leading immunosignature for T lymphocyte. Results: No relationship between ethnicity and the development of NODAT was identified. However, there was a significant difference in age between cohorts. Younger patients demonstrated a lower rate of NODAT while, NODAT reached its maximum in 40-60-year age group. IFNG TT genotype was significantly associated with NODAT (p=0.005), while IFNG AA was considerably higher in the non-NODAT group. Conclusion: Beside the conventional contributing factors of NODAT, our results might represent a suitable platform for a larger cytokine and chemokine spectrum genotyping.

Background: Astragalus possesses therapeutic effects for type 2 diabetes (T2D), while its action mechanisms remain to be elucidated. In view of the pathogenic associations between gut microbiota and T2D, we explored the effect of astragalus on gut-microbiota composition of T2D mice. Materials and methods: Modulation effects of astragalus on gut microbiota of T2D-model mice were assessed by 16S rRNA gene sequencing. Results: Inhibited blood-glucose and body-weight levels of T2D mice by astragalus were accompanied by gut microbiota-composition alteration. Astragalus administration significantly increased gut-microbiota richness and diversity in T2D mice and significantly altered the abundance of several bacterial taxa, inducing increased abundance of Lactobacillus and Bifidobacterium. PICRUSt software revealed the relationship between astragalus and T2D. Conclusion: Due to previously reported decreased gut-microbiota richness and diversity and reduced abundance of key species of Lactobacillus and Bifidobacterium, more studies are encouraged to explore the contribution of gut-microbiota alteration by astragalus to its anti-T2D effect.

Background: Fibrocalculous pancreatic diabetes (FCPD) is a secondary form of diabetes seen in patients with tropical chronic pancreatitis. Insulin deficiency plays a major role in the etiopathogenesis of FCPD. Limited data suggest a possible role of insulin resistance (IR) in the pathogenesis of FCPD. Sparse data exist on measures of insulin sensitivity (IS) and secretion in patients with FCPD and its comparison to type 2 diabetes mellitus (T2D) patients. Method: Eighty patients with FCPD, 36 patients with T2D and 36 healthy subjects were included. A 75 g oral glucose tolerance test (OGTT) was performed in the morning after an overnight fast. We evaluated IS and secretion using indices derived from fasting (homeostasis model assessment of insulin resistance [HOMA-IR], quantitative insulin sensitivity check index [QUICKI] and homeostasis model assessment of beta-cell function [HOMA-ß]) and OGTT (Matsuda, insulin sensitivity index by Kanauchi [ISI-K], oral glucose insulin sensitivity index [OGIS], Stumvoll, insulinogenic index and oral disposition index [ODI]) measurements of glucose and insulin. Results: HOMA-IR was significantly higher and QUICKI significantly lower in patients with FCPD and T2D than in healthy controls (P<0.001). Matsuda, ISI-K, OGIS and Stumvoll were significantly lower in patients with FCPD and T2D than in healthy controls (P<0.001), indicating reduced IS in both FCPD and T2D patients. HOMA-ß, insulinogenic index and ODI were significantly lower in patients with FCPD and T2D compared to healthy controls (P<0.001). Conclusion: FCPD is associated with reduced IS as assessed by fasting and OGTT-based indices. FCPD is also associated with a greater degree of impairment in insulin secretion than in T2D. IR may play a role in the pathogenesis of FCPD.

Purpose: Our goal was to study whether glycerol and xylitol provide protection against osmotic stress in keratinocytes. Methods: The experiments were performed on HaCaT keratinocytes. Hyperosmotic stress was induced by the addition of sorbitol (450, 500 and 600 mOsm). Both polyols were applied at two different concentrations (glycerol: 0.027% and 0.27%, xylitol: 0.045% and 0.45%). Cellular viability and cytotoxicity were assessed, intracellular Ca2+ concentration was measured, and the RNA expression of inflammatory cytokines was determined by means of PCR. Differences among groups were analyzed with one-way ANOVA and Holm-Sidak post-hoc test. When the normality test failed, Kruskal-Wallis one-way analysis of variance on ranks, followed by Dunn's method for pairwise multiple comparison was performed. Results: The higher concentrations of the polyols were effective. Glycerol ameliorated the cellular viability while xylitol prevented the rapid Ca2+ signal. Both polyols suppressed the expression of IL-1α but only glycerol decreased the expression of IL-1β and NFAT5. Conclusions: Glycerol and xylitol protect keratinocytes against osmotic stress. Despite their similar chemical structure, the effect of these polyols displayed differences. Hence, joint application of glycerol and xylitol may be a useful therapeutic approach for different skin disorders.

Background: This study aimed 1) to examine the impact of honey on diabetic foot; 2) to examine the effect of olive oil on diabetic foot; and 3) to compare the impact of honey and olive oil in the healing of diabetic foot. Methods: In this randomized controlled trial, 45 patients took part. Patients were randomly assigned to three groups. In the honey group, the wound was dressed using gauzes with honey daily for 1 month. In the olive oil group, the wound was dressed using gauzes with olive oil (4 mL) daily for 1 month. Patients in the control group received usual dressing. Wounds were assessed before and after intervention using the Wagner scoring system and the checklist of diabetic foot healing (where a higher score indicates better wound healing). Results: Demographic characteristics of patients in the three groups were similar. Mean scores of tissue around the wound, wound grade, wound drainage, and wound healing were similar before intervention in all three groups. After intervention, means score of tissue around the wound, wound grade, wound drainage, and wound healing were significantly higher in patients in the honey and olive oil groups compared to patients in the control group. Conclusion: The results of this study reveal that honey is as effective as olive oil in the treatment of diabetic foot. Given the few studies on this topic, further investigation is needed.

Purpose: The objective for this clinical pilot study was to evaluate changes to chronic pain, vascular health, and inflammatory markers when consuming a dietary supplement blend (DSB, CytoQuel®), containing curcumin, resveratrol, tocotrienols, N-Acetylcysteine, and epigallocatechin gallate. Materials and methods: An open-label study design was used where 21 study participants were evaluated at baseline and at 2 and 8 weeks after consuming DSB. Participants were randomized to consume 3 capsules once daily versus 2 capsules twice daily. Pain and activities of daily living questionnaires were used to gather subjective data on pain levels and interference with daily living. Blood pressure was measured in both arms and ankles, and the ankle-brachial index (ABI) calculated. Blood samples were used to evaluate markers associated with inflammation and cardiovascular health. Results: Highly significant reduction of chronic pain was seen after 8 weeks (p<0.01), both at rest and when physically active. Faster improvement was seen when consuming 3 capsules once daily, compared to 2 capsules twice daily. The pain reduction resulted in improved sleep quality (p<0.1), and improved social functioning (p<0.01), and less need for support from others (p<0.05), Normalization of mildly elevated ABI at study start was seen after 2 weeks. Plasma fibrinogen and von Willebrand Factor and serum matrix metalloproteinase-9 (MMP-9) showed reduction after 2 weeks (not significant), whereas a reduction in serum interleukin-1 receptor antagonist-a (IL-1ra) was statistically significant after 2 weeks (p<0.05). Correlation between pain reduction and changes to MMP-9 after 8 weeks was highly significant (P<0.01), whereas correlation between pain reduction and changes to IL-1ra reached significance at 2 weeks for the group consuming 3 caps once daily (p<0.04). Conclusion: Consuming DSB helped manage pain, increased comfort during daily activities, and improved vascular function. This was associated with selective effects on specific blood biomarkers associated with inflammation and vascular health.

  Background: Myeloid-derived suppressor cells (MDSCs) promote immunosuppression in the tumor microenvironment, support tumor growth and survival, and may contribute to immunotherapy resistance. Recent studies showed that tumor-derived exosomes (TDEs) can induce MDSCs accumulation and expansion, the mechanisms of which are largely unknown. Methods: The morphologies and sizes of the exosomes was observed by using a JEM-1400 transmission electron microscope. MicroRNA(miR)-107 and ARG1, DICER1, PTEN, PI3K, AKT, mTOR, and NF-kB mRNAs were quantified by quantitative reverse tanscription PCR. Dual-Luciferase Reports Assay were used to examine the expression of genes which was targeted by miR-107. The expression of proteins were analyzed by using western blot. Results: MiR-107 was not only overexpressed in gastric cancer cells but also enriched in their secreted TDEs. Also, these miR-107 enriched TDEs could be taken up by HLA-DR-CD33+MDSCs, where miR-107 was able to target and suppress expression of DICER1 and PTEN genes. Dampened DICER1 expression supported expansion of MDSCs , while decreased PTEN led to activation of the PI3K pathway, resulting in increased ARG1 expression. Furthemore, gastric cancer-derived miR-107 TDEs, when dosed intravenously into mice, were also capable of inducing expansion of CD11b+Gr1+/high MDSCs in mouse peripheral blood and altering expression of DICER1, PTEN, ARG1, and NOS2 in the MDSCs. Conclusions: Our findings demonstrate for the first time that gastric cancer-secreted exosomes are able to deliver miR-107 to the host MDSCs where they induce their expansion and activition by targeting DICER1 and PTEN genes, thereby may provide novel cancer therapeutics target for gastric cancer.

Purpose: Recent studies have validated microRNAs (miRNAs) as a diagnostic biomarker for haematological cancers. This study aimed to estimate the overall diagnostic accuracy of circulating miRNAs in haematological malignancies. Materials and Methods: Multiple databases (Google Scholar, PubMed, EMBASE, Cochrane Library,) were searched until 19th August 2017. Results: The meta-analysis included 50 studies from 20 publications. The diagnostic accuracy was assessed by pooled specificity, sensitivity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve area (AUC) by random effect model. We used QUADAS (Quality Assessment for diagnostic accuracy studies) to evaluate the quality of the included studies. To perform the meta-analysis, we used Meta-Disk 1.4, Revman 5.3 and Stata 12.0 software. High diagnostic accuracy was demonstrated, with a sensitivity of 0.81, a specificity of 0.85, a PLR of 5.28, an NLR of 0.22, a DOR of 30.39, and an AUC of 0.91. Subgroup analyses showed better outcomes for the African population, combined miRNAs and leukaemia patients compared with other subgroups. Conclusion: Our results indicated that circulating miRNAs especially combined miRNA can be used as a diagnostic marker in haematological cancers.

Purpose: To investigate the prevention effect of low-temperature atomization inhalation for radiation induced oral mucositis (OM) in patients with head and neck cancer (HNC) undergoing radiotherapy. Patients and methods: A total of 68 patients with HNC (including nasopharyngeal cancer) undergoing radiotherapy were divided into an intervention group (33 cases) and a control group (35 cases). During radiotherapy, the intervention group received low-temperature (between 4°C and 8°C) atomization inhalation; while the control group received normal temperature (between 18°C and 24°C) atomization inhalation. Atomization inhalation was performed twice a day, 20 minutes per time, using distilled water. The incidence and severity of OM was evaluated every week during radiotherapy. The comparation was made between the two groups. Results: The two groups were comparable among age, sex, Eastern Cooperative Oncology group (ECOG) score, body mass index (BMI) before radiotherapy, BMI loss during radiotherapy, original tumor site, pathological type, TNM stage, and mean oral cavity irradiated dose. There was a significant difference in the incidence of OM between the two groups (P<0.05). There were fewer patients with severe OM in the intervention group compared to the control group (P<0.05). The onset time of OM in the intervention group was delayed by about 4 days compared to that in the control group (P<0.05). Low-temperature atomization inhalation helped to avoid radiotherapy interruption in the intervention group. No patient in the intervention group suffered any adverse reaction for low-temperature atomization inhalation treatment. Conclusions: Low-temperature atomization inhalation can reduce the incidence and severity of OM, and slow down the progression process of it. It can be used as a new prevention method during radiotherapy, and should be promoted in clinical practice.

Two-thirds of cancer patients report taste disorders during and after chemotherapy. Taste disorders impact on nutritional status which is highly relevant for treatment efficacy and overall prognosis. Improvement of taste disorder is of particular importance for cancer patients' outcomes, thus the TASTE trial was conducted to improve taste disorders with a taste and smell training.

Objective: Many studies have shown that long non-coding RNAs (lncRNAs) are closely related to various cancers. This study aims to explore the roles of lncRNA HOXA11-AS in the development and progression of osteosarcoma (OS). Methods: The expression levels of HOXA11-AS and miR-125a-5p in tumor tissues and the adjacent tissues were detected by RT-PCR method. The proliferation, migration and invasion of MG-63 and KHOS cells were determined. Results: It was found that HOXA11-AS expression levels in OS tissues and OS cell lines were higher than those in OS adjacent tissues and normal human osteoblast cell lines. The higher expression level of HOXA11-AS was positively correlated with more severe clinical stage, distant metastasis and poor prognosis of OS. Inhibition of HOXA11-AS expression could reduce metastasis and invasion of OS cell lines. In addition, HOXA11-AS was found to be an endogenous inhibitor of miR-125a-5p, it down regulated the expression level of miR-125a-5p, and this process could promote the expression of Rab3D, the target gene of miR-125a-5p. Conclusion: Our study elucidated the role of a new HOXA11-AS/miR-125a-5p/Rab3D regulatory pathway in promoting OS metastasis.

Purpose: Esophageal cancer is a major cause of cancer-related mortality worldwide. The long noncoding RNA LINC00152 has been confirmed to play an oncogenic role in many cancers. However, the expression pattern and function of LINC00152 in human esophageal squamous cell carcinoma (ESCC) remain unclear. Materials and methods: We evaluated LINC00152 expression in ESCC by qPCR and in situ hybridization. Proliferation, apoptosis, cell cycle, migration and invasion were examined in ESCC cells knocked down for LINC00152 knockdown by siRNA. Furthermore, an mRNA microarray was performed in ESCC cells with LINC00152 knockdown. Results: LINC00152 was significantly upregulated in human ESCC clinical samples (P<0.001) and cell lines (P=0.008), and LINC00152 overexpression was related to lymphatic metastasis (P=0.03) and advanced pTNM classification (P=0.005). Furthermore, ESCC patients with LINC00152 overexpression had significantly shorter overall survival (P=0.007), and LINC00152 overexpression was an independent risk factor for overall survival of ESCC patients. LINC00152 knockdown inhibited the proliferation, migration and invasion of ESCC cells in vitro. In addition, mechanistic investigations through mRNA array and immunoblot analyses demonstrated that LINC00152 regulated the expression of several cell cycle-related proteins and SNARE (soluble N-ethylmaleimide-sensitive factor attachment protein receptors) interactions in vesicular transport pathway proteins. Conclusion: Our research indicated that LINC00152 exhibits oncogenic functions in ESCC and may represent a potential new target for ESCC therapy.

Background: Spatial attention could enhance the neural activities of attended locations in human visual cortex. As a salient stimulus, emotional image could enhance the responses in amygdala and visual areas. However, few studies examined the interaction of the attentional effects induced by emotional stimuli and spatial cues on the neural responses in visual areas. Methods: In the present study, we used functional magnetic resonance imaging (fMRI) to examine the combined and separated effects of emotional image and spatial cue on the activities in human visual areas. A revised Posner cueing paradigm was utilized. Each participant viewed a fearful image and a peaceful image simultaneously in left and right visual fields. A spatial cue of two dots was then presented in one of the image positions. In this manner, the attentional effects for emotional image and spatial cue could be isolated and combined. Results: The results showed that spatial cue enhanced the responses in V4, intraparietal sulcus (IPS) and lateral occipital area (LO), while emotional image could enhance the responses in V3, V4 and LO. Importantly, no significant interactions were found in any of the visual areas. Conclusion: Our results indicate that the two kinds of attentional modulation might not be affected by each other. These findings shed light on the neural mechanism of the emotional attention.

Background: Health care education is an important issue in the development of countries, and student's academic achievement plays an important role in this respect. Test anxiety can affect the academic performance of students. This study aimed to investigate the effect of study preparation on test anxiety and performance of public health students. Methods: This quasi-experimental study investigated the effect of study preparation on reducing test anxiety and improving the performance of public health students at Urmia University of Medical Sciences, Urmia, Iran, in the academic year 2016-2017. All second- and third-year bachelor's students in public health major were assigned into the intervention (n=20) and control groups (n=25). The assignment was based on the study preparation items and the defined benchmark. Data on general stress and test anxiety were collected by subjective self-assessment via paper-and-pencil surveys in the first week of the semester and before the final exam, respectively. Results: No significant difference was found in the level of general stress between the two groups at the beginning of the semester (p=0.55) based on the study preparation items. The level of test anxiety in the intervention group (47.90) was lower than in the control group (34.64) at the end of the semester (p=0.001). The mean value of exam scores was higher in the intervention group (p=0.015). Conclusions: The intervention reduced the level of test anxiety and improved the performance of students. Faculty members and heads of the departments should help students learn about the study preparation over the semester with engagement in learning-oriented approaches and class activities.