miR-708-5p deficiency involves the degeneration of mandibular condylar chondrocytes via the TLR4/NF-κB pathway.

OBJECTIVE: Ageing and aberrant biomechanical stimulation are two major risk factors for osteoarthritis (OA). One of the main characteristics of aged cartilage is cellular senescence. One of the main characteristics of osteoarthritic joints is cartilage degeneration. The cells in the temporomandibular joint (TMJ) cartilage are zonally arranged. The deep zone cells are differentiated from the superficial zone cells (SZCs). The purpose of the present study was to investigate whether degenerative shear stress (SS) stimulates the senescence programme in TMJ SZCs, and to determine which miRNA is involved in this process. METHOD: SZCs were isolated from the TMJ condyles of 3-week-old rats and treated with continuous passaging or SS. RNA sequencing was conducted to identify miRNA(s) that overlap with those involved in the replication senescence process and the SS-induced degeneration programme. Unilateral anterior crossbite (UAC), which is TMJ-OA inducible, was applied to 2-month-old and 12-month-old mice for 3 weeks. The effect of TMJ local injection of agomiR-708-5p was evaluated histologically. RESULTS: Both replication and SS treatment induced SZC senescence. miR-708-5p was identified. Knocking down miR-708-5p in SS-treated SZCs led to more severe senescence by alleviating the inhibitory impact of miR-708-5p on the TLR4/NF-κB pathway. miR-708-5p expression in mouse TMJ cartilage decreased with age. UAC induced more severe osteoarthritic cartilage lesions in 12-month-old mice than in 2-month-old mice. Injection of agomiR-708-5p suppressed UAC-induced osteoarthritic cartilage lesions. CONCLUSIONS: Age-related miR-708-5p deficiency is involved in the mechanically stimulated OA process. Intra-articular administration of agomiR-708-5p is a promising new strategy for OA treatment.

Rapid nanomolar detection of cocaine in biofluids by electrochemical aptamer-based sensor with low-temperature effect for drugged driving screening.

Cocaine is one of the most abused illicit drugs, and its abuse damages the central nervous system and can even lead directly to death. Therefore, the development of simple, rapid and highly sensitive detection methods is crucial for the prevention and control of drug abuse, traffic accidents and crime. In this work, an electrochemical aptamer-based (EAB) sensor based on the low-temperature enhancement effect was developed for the direct determination of cocaine in bio-samples. The signal gain of the sensor at 10 °C was greatly improved compared to room temperature, owing to the improved affinity between the aptamer and the target. Additionally, the electroactive area of the gold electrode used to fabricate the EAB sensor was increased 20 times by a simple electrochemical roughening method. The porous electrode possesses more efficient electron transfer and better antifouling properties after roughening. These improvements enabled the sensor to achieve rapid detection of cocaine in complex bio-samples. The low detection limits (LOD) of cocaine in undiluted urine, 50% serum and 50% saliva were 70 nM, 30 nM and 10 nM, respectively, which are below the concentration threshold in drugged driving screening. The aptasensor was simple to construct and reusable, which offers potential for drugged driving screening in the real world.

Semantic-Aware Fusion Network Based on Super-Resolution.

The aim of infrared and visible image fusion is to generate a fused image that not only contains salient targets and rich texture details, but also facilitates high-level vision tasks. However, due to the hardware limitations of digital cameras and other devices, there are more low-resolution images in the existing datasets, and low-resolution images are often accompanied by the problem of losing details and structural information. At the same time, existing fusion algorithms focus too much on the visual quality of the fused images, while ignoring the requirements of high-level vision tasks. To address the above challenges, in this paper, we skillfully unite the super-resolution network, fusion network and segmentation network, and propose a super-resolution-based semantic-aware fusion network. First, we design a super-resolution network based on a multi-branch hybrid attention module (MHAM), which aims to enhance the quality and details of the source image, enabling the fusion network to integrate the features of the source image more accurately. Then, a comprehensive information extraction module (STDC) is designed in the fusion network to enhance the network's ability to extract finer-grained complementary information from the source image. Finally, the fusion network and segmentation network are jointly trained to utilize semantic loss to guide the semantic information back to the fusion network, which effectively improves the performance of the fused images on high-level vision tasks. Extensive experiments show that our method is more effective than other state-of-the-art image fusion methods. In particular, our fused images not only have excellent visual perception effects, but also help to improve the performance of high-level vision tasks.

Sustainable natural chlorogenic acid as a functional molecular sensor toward viscosity detection in liquids.

Liquids are perishable at ease during the long-term transportation and storage processes, non-invasive and in situ inspection method is urgent to be developed. In consideration of the important role of viscosity, one kind of sustainable natural product chlorogenic acid (CA) extracted from honeysuckle has been used as a versatile optical sensor for viscosity determination during the liquid spoilage process. The natural molecule was conducted by the O-diphenyl and carboxylic acid ester groups in coincidence, a typical twisted intramolecular charge transfer phenomenon was formed. This sensor features wide adaptability, high selectivity, good sensitivity, and excellent photo stability in various liquids. And CA displays a larger Stokes shift, high viscosity sensitive coefficient (0.62), and narrower energy band. The rotatable conjugate structure can be acted as the recognition site, and the bright fluorescent signal of CA is specifically activated when in the high viscous micro-environment. Inspired by this objective phenomenon, CA has been applied to detect the thickening efficiency of various food thickeners. More importantly, the viscosity fluctuations during the deterioration stage of liquids can be screened through non-invasive and in situ monitoring. We expected that more natural products can be developed as molecular tools for liquids safety investigation, and fluorescent analytical methods can be expanded toward interdisciplinary research.

Blood protection of autologous platelet-rich plasma in long-time aortic root reconstruction: A retrospective study.

OBJECTIVE: This study aimed to investigate the blood protective effect of autologous platelet-rich plasma in aortic root reconstruction under longtime cardiopulmonary bypass. METHOD: Patients who underwent aortic root reconstruction between August 2018 and August 2022 were included and divided into experimental and control groups according to whether autologous platelet-rich plasmapheresis was used or not. The experimental group included 112 patients (90 males aged 39.00 [28.75-49.00] years), and the control group included 112 patients (90 males aged 37.00 [27.00-46.25] years). The clinical data for example EuroSCORE II cardiovascular surgery risk score, blood routine and other indicators were collected from the two groups. RESULTS: The transfusion volume of allogeneic red blood cells in the experimental group (52 cases without blood transfusion, 23 cases with 1-2 units, 15 cases with 3-4 units, and 22 cases with 5 units and above) was significantly lower than that in the control group (32 cases without transfusion, 34 cases with 1-2 units, 22 cases with 3-4 units, and 24 cases with 5 units or more) (Z = -2.06, p < 0.05). Resternotomy/thoracotomy occurred in 11 cases (9.8%) in the experimental group and 23 cases (20.5%) in the control group (RR = 2.37, 95% CI: 1.1-5.14, p < 0.05). The number of bleeding events in the experimental group (18 cases, 16.1%) was significantly less than that in the control group (33 cases, 29.5%) (RR = 2.18, 95% CI: 1.14-4.17, p < 0.05). CONCLUSIONS: The application of autologous platelet-rich plasma in a long-time cardiopulmonary bypass aortic root reconstruction can reduce the amount of allogeneic blood transfusion and the occurrence of bleeding events, which is beneficial for blood protection.

Utilization of photo-luminescent technique toward viscosity detection in the liquid food system with triphenylamine-michaelitic acid molecular sensor.

A noninvasive and effective viscosity inspection method is expected to ease the burden of continued increased health problems caused by liquid food safety. In this study, we proposed the viscosity of the liquid food micro-environment as a marker and further developed a versatile optical sensor, DPTMDD, for monitoring liquid food micro-environmental viscosity alterations. This sensor was strategically constructed by the triphenylamine-thiophene derivate and michaelitic acid, rotatable conjugate structure was utilized as the recognition site. The molecular sensor was synthesized in a one-step facile way, and DPTMDD displayed a longer emission wavelength (592 nm), low detection limit (1.419 cP), and larger Stokes shift (193.7 nm in glycerol and 177.8 nm in water) with narrower energy band, endowing the sensor with the capacity of achieving high signal-to-noise ratio imaging. Meanwhile, DPTMDD exhibits high adaptability, selectivity, sensitivity, and good photo-stability in various liquid foods, bright fluorescent signal (37.5-fold) of DPTMDD is specifically activated in the high viscosity media. Thickening efficiencies can be identified as well. More importantly, the viscosity fluctuations during the metamorphic stages of liquid foods are also screened through in situ monitoring. We expected that this unique strategy will reinvigorate the continued perfection of liquid food safety investigation systems. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-023-05699-y.

Reproduction Numbers of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Variants: A Systematic Review and Meta-analysis.

The coronavirus disease 2019 (COVID-19) pandemic continues to pose substantial risks to public health, worsened by the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants that may have a higher transmissibility and reduce vaccine effectiveness. We conducted a systematic review and meta-analysis on reproduction numbers of SARS-CoV-2 variants and provided pooled estimates for each variant.

Triphenylamine indanedione as an AIE-based molecular sensor with one-step facile synthesis toward viscosity detection of liquids.

Viscosity is one of the most important physical parameters in a liquid, noninvasive, and effective viscosity inspection method toward liquid safety that needs to be developed urgently. In this study, two kinds of novel molecular sensors, namely, DPBID and DPTMID, were strategically constructed by the triphenylamine indanedione derivates; the rotatable conjugate structure was utilized as the recognition site and fluorescence quencher. This couple of molecular sensors was synthesized in a one-step facile manner. DPTMID displayed longer emission wavelength and larger Stokes shift (195 nm in water, 138 nm in glycerol) with a narrower energy band. Moreover, DPTMID exhibited high selectivity, sensitivity, and significant fluorescence signal enhancement toward a higher viscous microenvironment. The molecular sensor displayed good photostability, selectivity, and universality in various commercial liquids and featured with typical aggregation-induced emission (AIE). With the aid of DPTMID, the thickening effects of liquid thickeners can be captured. More importantly, DPTMID was explored to visualize the viscosity fluctuations during the metamorphic stages of liquids, and it was found that the microenvironment viscosity level is closely related to the spoilage degree of liquids. The method with rapid detection, high sensitivity, cheap equipment, and fast results output toward food quality and safety inspection can be achieved through this study.

Frequency domain analysis and clinical outcomes of pulsatile and non-pulsatile blood flow energy during cardiopulmonary bypass.

INTRODUCTION: The superiority of pulsatile perfusion during cardiopulmonary bypass remains controversial. We analyzed the frequency-domain characteristics and organ protection of pulsatile and nonpulsatile flow in adult patients with valvular disease. METHODS: EEP and SHE were used to calculate blood flow energy in 60 patients. The Fast Fourier Transform was employed to analyze the power spectral density and power density ratio (Rvpd) of flow energy. Changes in endothelin-1, nitric oxide, interleukin-6,10, tumor necrotic factor, S100ß, NSE, blood and urinary ß2-microglobulin levels were investigated to assess the endothelial function, inflammatory reaction, kidney and brain injury during CPB. RESULTS: EEP and SHE in PP group at each time point were 1.52-1.62 times and 2.03-2.22 times higher respectively compared with NP group. Power spectral density analysis demonstrated that the blood flow energy frequencies in each group were all within 40 Hz and the low frequency energy (0-5 Hz) was dominant in physiological perfusion (>90%). The energy ratio of 0-5 Hz at radial artery was significantly decreased compared with that of post arterial filter in PP (81% vs 64%) and NP (63% vs 37%) group. The power density ratio (Rvpd) was higher than that of NP in all frequency ranges at the radial artery (9.51 vs 4.68 vs 3.59) and arterial filter (3.87 vs 2.69 vs 2.38). The S100ß, NSE Urinary and plasma ß2-microglobulin level were significantly increased at 6 and 24 hours after surgery in two group, and significantly higher in group NP. CONCLUSION: PP provided more energy than NP. The proportion of low frequency energy in the pulsatile or nonpulsatile flow is significantly reduced. The low-frequency energy is significantly attenuated during conduction to peripheral tissues in nonpulsatile flow. The surplus pulsatile energy influences the secretion of endothelial and inflammatory factors, and demonstrate better cerebral and kidney protective effect at the biological marker level.

The complete plastid genome of Cotinus coggygria and phylogenetic analysis of the Anacardiaceae.

Cotinus coggygria Scop. (Anacardiaceae) is an important ornamental tree with beautiful characteristics that is grown in China. In this study, the complete plastid genome of C. coggygria was sequenced and assembled. This genome was 158,843 bp in size and presented a typical tetrad structure, consisting of a large single-copy region (87,121 bp), a pair of inverted repeat regions (26,829 bp), and a small single-copy region (18,064 bp). A total of 134 genes were annotated, including 88 protein-coding genes, 38 tRNA genes, and 8 rRNA genes. We observed a deletion that caused the loss of the rpl32 gene, and a small expansion of IR regions resulted in the trnH gene accessing IR regions; two copies were obtained. Phylogenetic analysis showed that C. coggygria was most closely related to Pistacia, with 100% bootstrap support within Anacardiaceae. In this study, we report the plastid genome of Cotinus species for the first time, which provides insight into the evolution of the plastid genome in Anacardiaceae and promotes the understanding of Cotinus plants.

Tetranitrile-anthracene as a probe for fluorescence detection of viscosity in fluid drinks via aggregation-induced emission.

Viscosity is an important quality parameter for fluid drinks, which can serve as an indicator for the extent of food spoilage, since the viscosity of fluid drinks varies during the spoilage process. In this study, a near-infrared fluorophore based on tetranitrile-anthracene (TPAEQ) was designed for viscosity determination via aggregation-induced emission (AIE). With increased viscosity, TPAEQ showed enhanced emission at around 759 nm with a large Stokes shift of 195 nm in water. The probe TPAEQ was successfully used to monitor the viscosity changes during the food spoilage process for fluid drinks. Moreover, the probe TPAEQ has effectively been utilized to determine the mass concentrations of food thickeners added in the real fruit drinks. The approach for the viscosity determination could enable the on-site direct detection with convenient operation in food safety inspection applications.

Enhanced transfection efficiency by using a novel semi-attachment method in cell line and primary cells.

DNA transfection in cells is a key technique in biological studies. Cationic liposomes can form nanoparticle complexes with DNA and are widely used for gene delivery in mammalian cells. However, the major drawback of cationic liposomes is their low transfection efficiency in hard-to-transfect cells, such as primary cultured cells. In this study, we established a novel semi-attachment transfection method that showed remarkably improved transfection efficiency compared with traditional forward transfection method.

A fluorescent probe based on aggregation-induced emission for hydrogen sulfide-specific assaying in food and biological systems.

A fluorescent probe based on a triphenylamine benzopyridine platform for hydrogen sulfide (H2S) assaying has been designed and synthesized. As a result of the H2S-triggered cleavage reaction, the disappearance of the quenching effect of dinitrophenyl and the increased hydrophobicity in a poor solvent lead to the aggregation-induced emission (AIE) effect; consequently an obvious 'turn-on' fluorescence signal can be observed in this process. The probe TPANF features high selectivity towards H2S, low detection limit (0.17 µM), and good photostability and biocompatibility. Moreover, it has been successfully utilized to monitor H2S in food samples to distinguish the extent of food deterioration and to identify the H2S concentration variation in living cells. In addition, endogenous H2S in HCT-116 xenograft tumor tissues was imaged by using this probe. The approach could provide useful insight for the development of other activatable AIE-based probes that are potentially helpful for specific assaying in food chemistry and biological systems.

Feasibility Study of Advanced Neural Networks Applied to sEMG-Based Force Estimation.

To find out the feasibility of different neural networks in sEMG-based force estimation, in this paper, three types of networks, namely convolutional neural network (CNN), long short-term memory (LSTM) network and their combination (C-LSTM) were applied to predict muscle force generated in static isometric elbow flexion across three different circumstances (multi-subject, subject-dependent and subject-independent). Eight healthy men were recruited for the experiments, and the results demonstrated that all the three models were applicable for force estimation, and LSTM and C-LSTM achieved better performances. Even under subject-independent situation, they maintained mean RMSE% of as low as 9.07 ± 1.29 and 8.67 ± 1.14. CNN turned out to be a worse choice, yielding a mean RMSE% of 12.13 ± 1.98. To our knowledge, this work was the first to employ CNN, LSTM and C-LSTM in sEMG-based force estimation, and the results not only prove the strength of the proposed networks, but also pointed out a potential way of achieving high accuracy in real-time, subject-independent force estimation.

Chitosan scaffolds induce human dental pulp stem cells to neural differentiation: potential roles for spinal cord injury therapy.

Cell-based transplantation strategies hold great potential for spinal cord injury (SCI) repair. Chitosan scaffolds have therapeutic benefits for spinal cord regeneration. Human dental pulp stem cells (DPSCs) are abundant available stem cells with low immunological incompatibility and can be considered for cell replacement therapy. The purpose of this study is to investigate the role of chitosan scaffolds in the neural differentiation of DPSCs in vitro and to assess the supportive effects of chitosan scaffolds in an animal model of SCI. DPSCs were incubated with chitosan scaffolds. Cell viability and the secretion of neurotrophic factors were analyzed. DPSCs incubated with chitosan scaffolds were treated with neural differentiation medium for 14 days and then neural genes and protein markers were analyzed by Western blot and reverse transcription plus the polymerase chain reaction. Our study revealed a higher cell viability and neural differentiation in the DPSC/chitosan-scaffold group. Compared with the control group, the levels of BDNF, GDNF, b-NGF, and NT-3 were significantly increased in the DPSC/chitosan-scaffold group. The Wnt/ß-catenin signaling pathway played a key role in the neural differentiation of DPSCs combined with chitosan scaffolds. Transplantation of DPSCs together with chitosan scaffolds into an SCI rat model resulted in the marked recovery of hind limb locomotor functions. Thus, chitosan scaffolds were non-cytotoxic and provided a conducive and favorable microenvironment for the survival and neural differentiation of DPSCs. Transplantation of DPSCs might therefore be a suitable candidate for treating SCI and other neuronal degenerative diseases.

[Analysis of complications in 61 extracorporeal membrane oxygenation cases].

OBJECTIVE: To analyze the reason and treatment of the complications of 61 cases of extracorporeal membrane oxygenation (ECMO) in order to improve survival rate of ECMO treatment. METHODS: ECMO records from January 2007 to December 2014 in Shanghai Chest Hospital were investigated retrospectively focusing on complications. There were included 43 male and 18 female patients, age 3 to 66 years. Indications for ECMO included post-operative low cardiac output, viral myocarditis, bridge to heart transplantation, acute respiratory distress syndrome and myocardial infarction. There were 49 cases of veno-arterial ECMO and 12 cases of veno-venous ECMO. RESULTS: ECMO duration was 2 to 61 days. Among 43 patients, 37 patients weaned from ECMO successfully and 28 survived to discharge. Various complications occurred to 56 patients, including oxygenator plasma leakage(4 case times), circuit emboli (7), hemolysis (4), bleeding (34), infection (8), acute kidney injury (35), lower limb ischemia (8) and neurologic complications (6). There were 49 cases times of complications in survivors, while 61 cases times in death group. Bleeding (10 time cases) and acute kidney injury (33 time cases) happened in the death group. Progresses in ECMO technique had influences on complications in some parts. For instance, incidence of lower limb ischemia was 6/7 in cutdown cannulating group, but reduced to 2/42(4.8%) when semi-open technique was applied. CONCLUSIONS: Complications in ECMO are relative to patients' outcome intimately. Appropriate prevention and treatment of complication play a major role in the success of ECMO support. The incidences of certain complications reduce significantly due to progresses of equipment and medical experiences.

Turn-on mode probe based on the sustainable xanthohumol extract for the efficient viscosity response in a liquid system.

Viscosity is a typical physical parameter and plays an important role in nutrient transferring, diffusion process regulating and safety warning. Aberrant mitochondrial viscosity is closely associated with an imbalance in a liquid system. Nevertheless, there is currently a lack of convenient and efficient tools for the mutation of viscosity detection at the molecular level. Herein, a natural product xanthohumol (XTH) was extracted from Humulus lupulus and used to measure the microenvironmental viscosity. Due to the existence of carbonyl and phenolic hydroxyl groups, a typical twisted intramolecular charge transfer (TICT) was formed. The conjugated single and double bonds can be employed as the rotatable site. Consequently, a turn-on method based on viscosity response is developed. High sensitivity (x = 0.56) with a remarkable enhancement (55-fold) toward viscosity and a visualized fluorescent signal can be found. In addition, it displays a single selectivity with excellent photostability and pH stability in the complex liquid system. Using the extracted XTH, a typical application toward the liquid spoilage process was performed and a positive correlation was noted. Given the comprehensive properties of XTH, liquid safety inspection at a molecular level with natural source-extracted products can be obtained.

Self-rated health and health-related quality of life among cancer patients: the serial multiple mediation of anxiety and depression.

BACKGROUND: Health-related quality of life (HRQOL) in cancer patients has attracted increasing attention, which may be associated with self-rated health (SRH), anxiety, and depression. However, limited studies have focused on the mediating role of anxiety and depression in the relationship between SRH and HRQOL among cancer patients. Therefore, this study aims to explore the serial multiple mediating effects of anxiety and depression between SRH and HRQOL in cancer patients. METHODS: This cross-sectional study investigated a total of 565 hospitalized cancer patients in Anhui province in China from November 2020 to October 2021. SRH was assessed using a single-item measure, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) and HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Socio-demographic and clinical characteristics were analyzed using descriptive statistics. The relationships between SRH, anxiety, depression, and HRQOL were evaluated by Pearson correlation analysis. The serial multiple mediation of anxiety and depression was assessed by SPSS PROCESS macro. RESULTS: SRH, anxiety, depression and HRQOL were significantly correlated(P < 0.001). In comparison to the fair SRH, the good SRH exhibited a significantly positive direct effect (Effect = 0.2366, Bootstrap 95%CI: 0.0642 ~ 0.4090) and total effect on HRQOL (Effect = 0.4761, Bootstrap 95%CI: 0.2975 ~ 0.6546). Conversely, the poor SRH demonstrated a significantly negative total effect on HRQOL (Effect= -0.4321, Bootstrap 95%CI: -0.7544~ -0.1099). When considering the fair SRH as the reference group, the poor SRH displayed a negative indirect effect on HRQOL through the single mediation of anxiety (Effect= -0.1058, Bootstrap 95%CI: -0.2217~ -0.0107) and the serial mediation of anxiety and depression (Effect= -0.0528, Bootstrap 95%CI: -0.1233~ -0.0035). Conversely, the good SRH had a positive indirect impact on HRQOL through the single mediation of anxiety (Effect = 0.1153, Bootstrap 95%CI: 0.0583 ~ 0.1900) and depression (Effect = 0.0667, Bootstrap 95%CI: 0.0206 ~ 0.1234), as well as the serial mediation of anxiety and depression (Effect = 0.0575, Bootstrap 95%CI: 0.0192 ~ 0.1030). CONCLUSION: SRH can improve HRQOL through the decrease of anxiety and depression in cancer patients. Focusing on SRH would be beneficial for their mental health and HRQOL in cancer patients.

Mediating roles of activities of daily living and depression on the relationship between sleep quality and health-related quality of life.

This study aimed to explore the mediating effects of ADL and depression on the relationship between sleep quality and HRQOL among older people in rural China, while also exploring the moderating impact of loneliness. The study gathered data from a household survey conducted among 1587 Chinese rural older adults (mean age = 73.63 years). The collected data was analyzed using SPSS version 23.0 software (IBM, New York, USA) and the PROCESS macro version 4.0 program. The findings indicated a significant correlation between sleep quality, ADL, depression, loneliness and HRQOL. ADL and depression exhibited a chain mediation effect on the relationship between sleep quality and HRQOL. Notably, the association between sleep quality and HRQOL was entirely mediated by ADL and depression. Additionally, loneliness acted as a moderator in the relationship between ADL and HRQOL. The findings of this study suggest that interventions focusing on sleep quality should prioritize strategies for enhancing older adults' ADL and depression as integral components of promoting older adults' HRQOL.

Study on the evaluation and influencing factors of contracted residents on the coordination of primary medical institutions.

Background: The implementation of family doctor contract service is a pivotal measure to enhance primary medical services and execute the hierarchical diagnosis and treatment system. Achieving service coordination among various institutions is both a fundamental objective and a central element of contract services. Objective: The study aims to assess residents' evaluations and determining factors related to the coordination of health services within primary medical institutions across different regions of Shandong Province. The findings intend to serve as a reference for enhancing the coordination services offered by these institutions. Methods: The study employed a multi-stage stratified random sampling method to select three prefecture-level cities in Shandong Province with different economic levels. Within each city, three counties (districts) were randomly sampled using the same method. Within each county (district), three community health service centers and township health centers implementing family doctor contract services were selected randomly. Face-to-face questionnaire surveys were conducted with contracted residents using the coordination dimension of the revised Primary Care Assessment Tools Scale (PCAT) developed by the research team. Data analysis was conducted using such methods as one-way analysis of variance and multiple linear regression. Results: The sample included 3,859 contracted residents. The coordination dimension score of primary medical institutions averaged 3.41 ± 0.18, with the referral service sub-dimension scoring 3.60 ± 0.58 and the information system sub-dimension scoring 3.34 ± 0.65. The overall score of the referral service sub-dimension surpassed that of the information system sub-dimension. Regression results indicated that the city's economic status, the type of contracted institutions, gender, education, marital status, income, occupation, health status, and endowment insurance payment status significantly influenced the coordinated service score of primary medical institutions (p < 0.05). Conclusion: The coordination of primary medical institutions in Shandong Province warrants further optimization. Continued efforts should focus on refining the referral system, expediting information infrastructure development, enhancing the service standards of primary medical institutions, and fostering resident trust. These measures aim to advance the implementation of the hierarchical diagnosis and treatment and two-way referral system.