NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy

ABSTRACT

Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

Guidelines for endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA): Joint Indian Chest Society (ICS)/Indian Association for Bronchology (IAB) recommendations

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

Ultrasonic investigation of materials-An avenue for project-based learning

Project-based learning (PBL) provides an effective practical application to the learners. Further, PBL develops problem-solving, critical thinking, etc., in the learner. This paper describes a type of project offered to the students at the collegiate level to enhance the students' ability to work in a team, manage a project, and present their results. These projects use acoustic waves in the ultrasound frequency range that can be used as a powerful nondestructive tool for the characterization of the materials. In situ measurement of the ultrasonic longitudinal velocity and evaluation of the elastic constants carried out on the materials in solid pellet form over a wide range of temperatures at a fundamental frequency of 5 MHz enables the study of various phase transitions, such as metal to insulator, ferromagnetic to paramagnetic, and even structural phase transitions that occur in the materials. Here, the investigation is elaborated on using ultrasonic waves on some materials in pellet form and the results obtained are presented.

The cricothyroid versus the spray-as-you-go method for topical anesthesia during flexible bronchoscopy: A systematic review and meta-analysis of randomized controlled trials

Background

Lignocaine can be administered during bronchoscopy using either a direct injection through the cricothyroid membrane (the cricothyroid method) or a spray of lignocaine solution through the bronchoscope working channel (the spray-as-you-go method). In this meta-analysis of randomized controlled trials (RCTs), we compared the efficacy of these two methods for topical anesthesia during flexible bronchoscopy.

Methods

We performed a systematic search to extract the relevant RCTs comparing the two techniques.

Results

Five RCTs meeting the inclusion criteria (747 subjects) were identified. The cricothyroid method was associated with significantly less cough (standardized mean difference [SMD] = -1.18, 95% confidence interval [CI] [-1.75, -0.62], P < 0.001, significant heterogeneity I² = 86%, P < 0.001). On analysis of secondary outcomes, the cricothyroid method was associated with a greater operator-rated procedure satisfaction (SMD = 1.00, 95% CI [0.74, 1.25], P < 0.001), less time for upper airway negotiation (mean difference, MD = -0.99, 95% CI [-1.37, -0.6], P < 0.001), and a significantly less cumulative dose of lignocaine administered (MD = -68.12, 95% CI [-130.18, -6.06], P = 0.03). The overall procedure duration (MD = 0.08, 95% CI [-0.09, 0.24], P = 0.36) and patient discomfort (MD = -0.08, 95% CI [-0.38, 0.22], P = 0.59) were not different between the two methods. There was no significant publication bias (P = 0.94).

Conclusions

The cricothyroid method is associated with less cough during flexible bronchoscopy. Other advantages are a greater operator-rated procedure satisfaction at a less cumulative lignocaine dose. These findings highlight the superior performance characteristics of the cricothyroid method for lignocaine administration for flexible bronchoscopy.

Ergonomics and efficient workplace design for hand-sewn footwear artisans in Kolhapur, India

BACKGROUND: The footwear manufacturing industry is one of the significant sectors of leather businesses in India. In the Indian footwear production industry, there is an enormous potential for employment, export, and development. Kolhapuri footwear is a popular handmade craft in India. It is a well-designed craft used by Indian people for many years. Artisans using traditional tools manufacture this footwear manually. Workers of this craft use traditional methods and work in cottage-based enterprises where organized laws and legislations are not applicable. Therefore, any occupational hazard-related documentation is not available. Due to the nature of the job, workers occupy various apparent non-optimal postures that may cause multiple work-related disorders such as musculoskeletal disorders (MSDs). OBJECTIVE: The main objective was to study and assess different footwear manufacturing workstations and working postures. The work further aimed to improve the design of current workstations and evaluate the proposed design using virtual ergonomic assessment techniques. METHODS: An anthropometric database for the Kolhapuri footwear making population was developed. This work measured 35 different body dimensions of the footwear manufacturing artisans. Rapid Upper Limb Assessment (RULA) was used for postural analysis of the artisans. RESULTS: It was observed that the entire footwear making activity was carried out in awkward postures. RULA scores suggested that ‘a change in posture’ to improve the efficiency of artisans was required for most of the workstations. This work proposed a novel workstation design to reduce the high risk of MSDs. The design was evaluated for thigh clearance, vision analysis and RULA analysis with the help of Digital Human Modelling (DHM). The virtual ergonomics assessment of this design revealed that the vision, thigh clearances, and RULA scores were satisfactory in the new design. CONCLUSION: The anthropometric database proposed in this study is likely to be useful in designing Kolhapuri footwear manufacturing tools. The proposed workstation and work layout are helpful to improve the accessibility of required tools and materials to footwear workers. It also helps to reduce occupational risks by easing uncomfortable work positions.

Molluscum contagiosum in a 12-year-old child - report of a case and review of literature

Molluscum contagiosum (MC) is an infection of the skin and mucous membrane caused by a DNA virus from the poxvirus family. It usually affects any part of the body and presents as pearly, flesh colored dome shaped nodule with a central umbilication. Clinical diagnosis can be supplemented with histopathology for the confirmed diagnosis of MC. This article presents a case of 12-year-old male child afflicted with MC along with a review of the literature on MC.

Arene platform based hexa-amide receptors for anion recognition: single crystal X-ray structural and thermodynamic studies

Compartmental recognition of [Cl₂(inf>O/inf>O)₂]²⁻ in the cavity of p-fluoro-phenyl substituted hexa-amide receptor.

High prevalence of circulating autoantibodies against thyroid hormones in vitiligo and correlation with clinical and historical parameters of patients

BACKGROUND

Autoantibodies against thyroid hormones (THAbs) directed towards triiodothyronine (T3-Ab) and/or thyroxine (T4-Ab) are very rare in the general population. They are increased in some nonthyroidal autoimmune diseases, where they seem to predict autoimmune thyroid disorders (ATDs). So far, their presence in patients with vitiligo has not been evaluated, but it might have a possible predictive role.

OBJECTIVES

To assess the prevalence of THAbs in a group of vitiligo patients and to correlate their presence with clinical and historical parameters.

METHODS

In total 79 patients with nonsegmental vitiligo and 100 controls were examined. Clinical characteristics of vitiligo and family and personal medical history were evaluated. Antinuclear autoantibodies, thyroid hormones and thyroid autoantibodies were measured. IgM T3-Ab, IgG T3-Ab, IgM T4-Ab and IgG T4-Ab were assayed by a radioimmunoprecipitation technique. Fisher's test, Student's t-test and χ(2)-test were used for statistical analysis.

RESULTS

Overall 77 of 79 patients (97%) had at least one type of THAb (11 T3-Ab, 10 T4-Ab, 56 both). In the control group, only one person (1%) had THAbs. In patients with vitiligo, T3-Abs were significantly associated with leucotrichia (IgM+IgG, P = 0.033; IgG, P = 0.039; IgM, P = 0.005) and thyroglobulin autoantibodies (IgM+IgG, P = 0.031; IgG, P = 0.058), while the absence of T3-Ab was related to personal history of cancer (IgM+IgG, P = 0.021; IgG, P = 0.039). T4-Abs were significantly associated with vitiligo activity (IgM+IgG, P < 0.001; IgM, P = 0.037) and duration (IgG, P = 0.013).

CONCLUSIONS

The surprisingly high prevalence of THAb in patients with vitiligo and their associations suggest a possible pathogenetic role in the disease and stress the tight link between vitiligo and ATDs. Further evaluation in a larger group of patients and an adequate follow-up are needed to define their potential predictive role.

Encapsulation of [X2(H2O)4]2- (X = F/Cl) clusters by pyridyl terminated tripodal amide receptor in aqueous medium: single crystal X-ray structural evidence

A new tris-amide receptor L based on 1,3,5-methyl substituted benzene platform and pyridyl as an attached unit is synthesized and explored towards anion recognition in aqueous environment. The presence of pyridyl terminal in L facilitates its aqueous solubility. The binding of halides and oxyanions towards L are examined by (1)H-NMR technique in solution and by single crystal X-ray crystallography in solid state studies. Crystallization of fluoride and chloride with L is carried out in acetone-water (1 : 1, v/v) binary solvent mixture that yields crystals for respective host-guest complexes, [L]2·[F2(H2O)4]·[TBA]2 (1) and [L]2·[Cl2(H2O)4]·[TBA]2 (2) suitable for single crystal X-ray diffraction studies. On the other hand, complexation of L with fluoride in dioxane-acetone (1 : 1, v/v) solvent mixture, results the formation of SiF6(2-) encapsulated complex, [L]2·[SiF6(H2O)2]·[TBA]2 (3). Crystallographic result shows the formation of [F2(H2O)4](2-) and [Cl2(H2O)4](2-) zipped 1D-polymeric tweezer-like assemblies of L in acetone-water (1 : 1, v/v) binary solvent mixture in complexes 1 and 2 respectively. Solution state (1)H-NMR studies in D2O-acetone-d6 (1 : 19, v/v) support 1 : 4 (host-guest) binding stoichiometry of F(-), Cl(-), Br(-), NO3(-), HSO4(-) and H2PO4(-) with L. Binding constants of these investigated anions with L by 1 : 1 binding model are calculated which show the following binding order: NO3(-) ≈ HSO4(-) > F(-) ≈ Cl(-) ≈ Br(-) > H2PO4(-). Further, solution state (19)F-NMR studies are also carried out to establish the F(-) binding with L in DMSO-d6.

Malassezia skin diseases in humans

Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection, such as pityriasis versicolor (PV) and Malassezia folliculitis. Moreover the yeasts of the genus Malassezia have been associated with seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and, less commonly, with confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. The study of the clinical role of Malassezia species has been surrounded by controversy due to the relative difficulty in isolation, cultivation, and identification. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. Moreover, since there exists little information about the epidemiology and ecology of Malassezia species in the Italian population and the clinical significance of these species is not fully distinguished, we will report data about a study we carried out. The aim of our study was the isolation and the identification of Malassezia species in PV-affected skin and non-affected skin in patients with PV and in clinically healthy individuals without any Malassezia associated skin disease.

Non-segmental vitiligo and psoriasis comorbidity - a case-control study in Italian patients

BACKGROUND

A recent systematic evaluation of vitiligo and psoriasis comorbidity has not yet been reported in a large series of patients with vitiligo.

OBJECTIVE

To investigate the practical/clinical implications in subjects with both vitiligo and psoriasis compared to those with vitiligo alone.

METHODS

This was a case-control study on 463 vitiligo patients in our clinic from March 2008 to April 2011. Medical assessment was performed by dermatologists using the modified Vitiligo European Task Force form.

RESULTS

In an univariate analysis, inflammation/pruritus [odds ratio (OR) 2.42, P = 0.03], use of drugs that can induce psoriasis (OR 2.74, P = 0.01), a family history (FH) of psoriasis (OR 2.87, P = 0.02), cardiovascular disease (OR 5.70, P = 0.001), hypertension (OR 4.7, P = 0.006) and type 2 diabetes mellitus (OR 3.87, P = 0.004), were significantly correlated with patients exhibiting vitiligo and psoriasis comorbidity. A trend was found in personal history of cardiovascular disease in patients with both diseases (OR 2.99, P = 0.07). FH of vitiligo was significantly associated with patients having only vitiligo (OR 0.35, P = 0.05). Multivariate analysis demonstrated that inflammation/pruritus in vitiligo macules (OR 2.56, P = 0.047) and a FH of cardiovascular disease (OR 4.07, P = 0.02) were the most significant predictors of patients having both psoriasis and vitiligo, while the presence of organ-specific autoantibodies (OR 0.24, P = 0.007) was significantly associated with patients having only vitiligo.

CONCLUSION

The presence of vitiligo and even mild psoriasis is significantly correlated with a family history of cardiovascular disease, a factor that requires greater attention and follow-up with respect to that necessary for vitiligo patients.

Influence of certain forces on evolution of synonymous codon usage bias in certain species of three basal orders of aquatic insects

Forces that influence the evolution of synonymous codon usage bias are analyzed in six species of three basal orders of aquatic insects. The rationale behind choosing six species of aquatic insects (three from Ephemeroptera, one from Plecoptera, and two from Odonata) for the present analysis is based on phylogenetic position at the basal clades of the Order Insecta facilitating the understanding of the evolution of codon bias and of factors shaping codon usage patterns in primitive clades of insect lineages and their subtle differences in some of their ecological and environmental requirements in terms of habitat-microhabitat requirements, altitudinal preferences, temperature tolerance ranges, and consequent responses to climate change impacts. The present analysis focuses on open reading frames of the 13 protein-coding genes in the mitochondrial genome of six carefully chosen insect species to get a comprehensive picture of the evolutionary intricacies of codon bias. In all the six species, A and T contents are observed to be significantly higher than G and C, and are used roughly equally. Since transcription hypothesis on codon usage demands A richness and T poorness, it is quite likely that mutation pressure may be the key factor associated with synonymous codon usage (SCU) variations in these species because the mutation hypothesis predicts AT richness and GC poorness in the mitochondrial DNA. Thus, AT-biased mutation pressure seems to be an important factor in framing the SCU variation in all the selected species of aquatic insects, which in turn explains the predominance of A and T ending codons in these species. This study does not find any association between microhabitats and codon usage variations in the mitochondria of selected aquatic insects. However, this study has identified major forces, such as compositional constraints and mutation pressure, which shape patterns of codon usage in mitochondrial genes in the primitive clades of insect lineages.

Molecular phylogeny of the cyprinid tribe Labeonini (Teleostei: Cypriniformes)

The cyprinid tribe Labeonini (sensuRainboth, 1991) is a large group of freshwater fishes containing around 40 genera and 400 species. They are characterized by an amazing diversity of modifications to their lips and associated structures. In this study, a total of 34 genera and 142 species of putative members of this tribe, which represent most of the generic diversity and more than one third of the species diversity of the group, were sampled and sequenced for four nuclear genes and five mitochondrial genes (totaling 9465bp). Phylogenetic relationships and subdivision of this tribe were investigated and the placement and status of most genera are discussed. Partitioned maximum likelihood analyses were performed based on the nuclear dataset, mitochondrial dataset, combined dataset, and the dataset for each nuclear gene. Inclusion of the genera Paracrossochilus, Barbichthys, Thynnichthys, and Linichthys in the Labeonini was either confirmed or proposed for the first time. None of the genera Labeo, Garra, Bangana, Cirrhinus, and Crossocheilus are monophyletic. Taxonomic revisions of some genera were made: the generic names Gymnostomus Heckel, 1843, Ageneiogarra Garman, 1912 and Gonorhynchus McClelland, 1839 were revalidated; Akrokolioplax Zhang and Kottelat, 2006 becomes a junior synonym of Gonorhynchus; the species Osteochilus nashii was found to be a member of the barbin genus Osteochilichthys. Five historical hypotheses on the classification of the Labeonini were tested and rejected. We proposed to subdivide the tribe, which is strongly supported as monophyletic, into four subtribes: Labeoina, Garraina, Osteochilina, and Semilabeoina. The taxa included in each subtribe were listed and those taxa that need taxonomic revision were discussed.

Autoimmune signals in non-segmental vitiligo patients are associated with distinct clinical parameters and toxic exposures

BACKGROUND

Although non-segmental vitiligo is commonly considered an autoimmune disease, the possible differences between non-segmental vitiligo patients with and without autoimmune signals have not been clearly established.

OBJECTIVE

To perform a comparison of non-segmental vitiligo patients with autoimmune signals (AIS) vs. those without autoimmune signals (NAIS) in regards to clinical characteristics and toxic/drug exposure.

METHODS

112 vitiligo patients were selected for a sex and age matched (1 : 1) case control study at an university based dermatology outpatient hospital specialized in pigmentary disorders. Medical assessment was performed by dermatologists using the modified Vitiligo European Task Force form and serological and clinical signs of autoimmunity were evaluated.

RESULTS

Disease duration, age of onset, patient history of cardiovascular disease, past smoking history, use of drugs, and consummation of goitrogenic foods were all significantly increased in the AIS group using McNemar's test for matched pairs. In our conditional regression model, the simultaneous presence of disease duration, use of prescription drugs, and consummation of goitrogenic foods were the best predictors of AIS vitiligo patients.

CONCLUSION

The evaluation of non-segmental vitiligo patients according to the presence vs. the absence of autoimmune signals allows us to correlate patients exhibiting autoimmune phenomenon with certain clinical characteristics, namely long disease duration, use of prescription drugs, and consumption of goitrogenic substances. In the presence of the aforementioned clinical profile, we suggest an evaluation of autoimmune signals.

Population genomics of wild and laboratory zebrafish (Danio rerio)

Understanding a wider range of genotype–phenotype associations can be achieved through ecological and evolutionary studies of traditional laboratory models. Here, we conducted the first large-scale geographic analysis of genetic variation within and among wild zebrafish (Danio rerio) populations occurring in Nepal, India, and Bangladesh, and we genetically compared wild populations to several commonly used lab strains. We examined genetic variation at 1832 polymorphic EST-based single nucleotide polymorphisms (SNPs) and the cytb mitochondrial gene in 13 wild populations and three lab strains. Natural populations were subdivided into three major mitochondrial DNA clades with an average among-clade sequence divergence of 5.8%. SNPs revealed five major evolutionarily and genetically distinct groups with an overall F_ST of 0.170 (95% CI 0.105–0.254). These genetic groups corresponded to discrete geographic regions and appear to reflect isolation in refugia during past climate cycles. We detected 71 significantly divergent outlier loci (3.4%) and nine loci (0.5%) with significantly low F_ST values. Valleys of reduced heterozygosity, consistent with selective sweeps, surrounded six of the 71 outliers (8.5%). The lab strains formed two additional groups that were genetically distinct from all wild populations. An additional subset of outlier loci was consistent with domestication selection within lab strains. Substantial genetic variation that exists in zebrafish as a whole is missing from lab strains that we analysed. A combination of laboratory and field studies that incorporates genetic variation from divergent wild populations along with the wealth of molecular information available for this model organism provides an opportunity to advance our understanding of genetic influences on phenotypic variation for a vertebrate species.

Autoimmune markers in vitiligo patients appear correlated with obsession and phobia

BACKGROUND

Current studies have treated a limited portion of the subjective aspects of vitiligo patients and have yet to elucidate possible psychological differences between those with autoimmune markers (AIM) with respect to those without autoimmune markers (NAIM).

OBJECTIVE

To perform an age and gender-matched 1:1 case-control study through a comparison of non-segmental vitiligo patients with autoimmune features vs. those without autoimmune features in regards to psychiatric features, psychosomatic aspects and social parameters.

METHODS

A total of 112 non-segmental vitiligo patients have been examined at the Florence University dermatology outpatient service (2nd dermatology unit). Vitiligo with an autoimmune background was defined by the presence of autoimmune antibodies and/or autoimmune diseases. Psychiatric screening was performed by dermatologists using the modified Middlesex Healthcare Questionnaire (MHQ); psychosomatic aspects and social impact were analysed with a standardized, Florentine questionnaire.

RESULTS

Upon performing a conditional regression model, age, phobia and obsession were significantly predictive of the presence of AIM and a low total MHQ score was significantly predictive of NAIM in vitiligo patients. With univariate analysis, we found significant differences in: identifiable stress related to the onset of vitiligo, vitiligo triggered by stress, and modified interpersonal relationships related to vitiligo, which were associated with the subgroup containing autoimmunity markers.

CONCLUSIONS

We found a higher prevalence of age, obsession and phobia among vitiligo patients AIM as compared to vitiligo patients NAIM. Thus, in the presence of demonstrated autoimmunity, screening for particular psychiatric aspects may be useful in the clinical practice of vitiligo.

Common variable immunodeficiency in vitiligo

Three cases of adult, non-segmental vitiligo patients in which primary, common variable immunodeficiency (CVID) was present are described. In two of the three cases, psoriasis was also present. Onset of CVID was diagnosed before vitiligo in two patients, and subsequent to the onset of vitiligo in the remaining patient. A family history of CVID was negative in all three cases. In contrast, a family history of vitiligo was present in two cases and a family history of psoriasis was present in one case. In regards to vitiligo, disease onset was gradual, with active disease in two cases, while the third case had an abrupt disease onset with borderline activity during clinical presentation. Cutaneous disease extension ranged from 2% to 12.3% in the three cases. Upon physical exam, Koebner phenomenon and signs of inflammation, such as pruritus were present in two patients; one of whom had scalp leukotrikia as well. Stress was a triggering factor in the development of vitiligo in two cases. The presence of CVID due to drugs or diseases known to cause secondary antibody deficiency were excluded in all three patients. Lastly, all patients were under treatment with immunoglobulin replacement therapy, which did not change the outcourse of vitiligo.

Formation of a nitrate zipped dimeric capsule and un-zipping by chloride doping

A dimeric capsular aggregation of two units of arene capped tripodal receptor stitched together by a planar anion, such as nitrate, and ruptured by a spherical anion like chloride in aqueous medium.

Anion complexation of a pentafluorophenyl-substituted tripodal urea receptor in solution and the solid state: selectivity toward phosphate

The binding and selectivity of halides (spherical) and oxyanions (tetrahedral) toward a recently reported pentafluorophenyl-substituted tripodal urea-based receptor L(1) are examined thoroughly in the solid state by single-crystal X-ray crystallography as well as in solution by multinuclear NMR techniques. Crystallographic results show proof of a fluoride encapsulation in the cavity of L(1) in complex [L(1)(F)][Bu(4)N], . Fluoride encapsulation inside the C(3v) symmetric cleft is observed via six hydrogen bonds to all six urea protons of the receptor. In case of complex crystallographic results show encapsulation of sulfate ion inside a supramolecular cage formed upon 1 : 2 (guest-host) complex formation between sulfate and L(1). Sulfate encapsulation is observed via fourteen hydrogen bonding interactions from all six urea moieties of two L(1) units. Our effort to isolate single crystal of halides/oxyanions complexes of L(2) always yield single crystals of free L(2) though literature shows anion binding with this receptor in solution. Solution state binding studies of L(1) are carried out by (1)H-NMR titration to calculate binding constants, which show the following anion binding sequence H(2)PO(4)(-) > SO(4)(2-)> CH(3)COO(-) > F(-) > Cl(-) >> Br(-) whereas there is no binding with I(-), NO(3)(-) and ClO(4)(-) guests. Comparison of phosphate and sulfate binding in L(1) and L(2), show higher binding with the pentafluorophenyl substituted receptor, L(1). Further (19)F and (31)P-NMR experiments in solution are also carried out to probe the binding of F(-) and H(2)PO(4)(-) with L(1), respectively. Extensive (1)H-NMR experiments in solution and crystallization in the presence of multiple anions are also undertaken to evaluate the selectivity of H(2)PO(4)(-) over other anions.