Success to Clear the Bar in Elite Pole Vaulters is Affected by Step Frequency Perturbation.

The purpose of the study was to identify the interaction of step characteristics, along with the direction and magnitude of their asymmetry of elite male and female pole vaulters between successful and failed attempts. It was hypothesized that step characteristics and the magnitude of asymmetry between the two legs would interact with the outcome of the attempt. The approach runs of 12 pole vaulters (7 males, 5 females) were recorded during an indoor international competition. The leg used by the athlete for taking-off was defined as the non-pole-carrying leg, while the other was the pole-carrying leg. Using spatiotemporal information obtained from recordings with a panning camera (300 fps), the last steps of each athlete's approach run were analyzed for length, frequency, average velocity, and inter-limb asymmetry. There was no inter-limb difference (p > 0.05) in the absolute values of step length or step velocity between successful and failed attempts. However, the pole-carrying leg presented significantly (p < 0.05) higher step frequency values at the failed attempts. There was no significant difference (p > 0.05) in asymmetry values for step length, frequency, and average velocity between successful and failed attempts. Although step velocity remained unaffected, failed attempts were characterized by a perturbation in the interaction of step frequency and step length. The present findings suggest that although high velocity at the final phase of the approach is essential, it is not the sole determining factor for a successful attempt.

Prevalence, Serotypes, Antimicrobial Resistance and Biofilm-Forming Ability of Listeria monocytogenes Isolated from Bulk-Tank Bovine Milk in Northern Greece.

The prevalence of Listeria monocytogenes in bovine bulk-tank milk (BTM) in Greece has not been previously investigated. The aim of the study was to estimate the prevalence of L. monocytogenes in bovine BTM in Greece and to characterize the isolates in terms of carriage of genes encoding for pathogenic determinants, assess the isolates' biofilm-forming ability and determine their susceptibility against 12 antimicrobials. Samples (n = 138) of bovine BTM were obtained from farms located throughout Northern Greece and were analyzed qualitatively and quantitatively for L. monocytogenes. Five samples (3.6%) tested positive for L. monocytogenes. The pathogen's populations in these positive samples were below 5 CFU/mL. Most isolates belonged to the molecular serogroup "1/2a, 3a". All isolates carried the virulence genes inlA, inlC, inlJ, iap, plcA and hlyA, but actA was detected in only three isolates. The isolates displayed weak to moderate biofilm-forming ability and distinct antimicrobial resistance profiles. All isolates were characterized as multidrug resistant, with resistance to penicillin and clindamycin being a common feature. Considering that L. monocytogenes constitutes a serious public health threat, the key findings of the study, related to the carriage of virulence genes and multidrug resistance, highlight the importance of continued monitoring of the pathogen in farm animals.

Growth and survival of Listeria monocytogenes during the manufacture and storage of artisanal kefir.

This study aimed to evaluate the behavior of Listeria monocytogenes during the manufacture and storage of artisanal kefir. A five-strain cocktail of L. monocytogenes was introduced (at ca. 3.0 log10 CFU/mL) into UHT milk as a pre-fermentation contaminant. The growth of L. monocytogenes, lactic acid bacteria and yeasts was monitored during the 24-h fermentation period of milk with two types of kefir grains at 20 °C and the subsequent storage of kefir under adequate (4 °C) and inadequate (10 °C) refrigerated-storage conditions. L. monocytogenes grew into much higher cell densities (5.3-5.8 log10 CFU/mL) by the end of the fermentation period, but the final (24-h) counts were substantially lower than those obtained in the corresponding control trials with unfermented milk (7.2 log10 CFU/mL). The growth rate of L. monocytogenes during fermentation differed depending on the type of kefir grain used. During the subsequent 11-day storage of the kefir filtrates at 4 °C or 10 °C, the behavior of L. monocytogenes varied from no growth to further population increases (of up to 1.1 log10 CFU/mL), depending on the storage temperature, but also depending on the type of kefir grain and the grain surface-to-weight ratio that had been used to ferment the milk. This study highlights the need for strict adherence to good hygiene practices during artisanal kefir making and shows that L. monocytogenes can sustain considerable growth during milk fermentation and further grow during the subsequent cold storage of kefir, particularly under inadequate refrigerated storage conditions.

Pivot Step Jump: A New Test for Evaluating Jumping Ability in Young Basketball Players.

Jumping ability in basketball is usually assessed using standardized vertical jump tests. However, they lack specificity and do not consider the player's basketball skills. Several studies have suggested performing specific jump tests, which are tailored to the movement patterns and requirements of a basketball game. The pivot step jump test (PSJT) is a novel test designed to evaluate the specific jumping abilities of basketball players by combining a pivot step on one leg with a maximum bilateral vertical jump. This study had two aims: to determine the reliability and validity of the PSJT using typical jump tests as the criterion measure and to demonstrate the PSJT as a practical test to evaluate specific jumping ability in young male and female basketball players. Twenty female (EGA; 14.0 ± 0.7 years, 59.3 ± 7.9 kg, 162.1 ± 5.5 cm) and fifteen male (EGB; 14.0 ± 0.7 years, 58.1 ± 7.7 kg, 170.3 ± 6.4 cm) basketball players participated in the study. The test−retest reliability of the PSJT within sessions (intrasession reliability) and across sessions (intersession reliability) was assessed within EGA. For the evaluation of validity, EGB performed the PSJT and a series of criterion jumping tests. For EGA, no changes (p > 0.05) were found in PSJT performance between test sessions and excellent intra- and intersession reliability was observed (ICCs > 0.75). Correlation coefficients indicated high factorial validity between the jumping tests and PSJT (r = 0.71−0.91, p < 0.001). The PSJT appears to offer a valid assessment of jumping ability in basketball and is a practical test for assessing sport-specific jumping skills in young basketball players.

Genetic characterization of livestock-associated methicillin-resistant Staphylococcus aureus isolated in Greece.

The interest in livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) strains is increasing due to their wide distribution and transmission even in persons without previous contact with livestock, and these strains pose a public health threat. The aim of the study was the genetic characterization of the whole genome of two epidemiologically unrelated t034 LA-MRSA strains previously isolated from the nasal cavities of a goat and a farmer in Greece. Both strains were assigned to the ST398-Vc-t034 type and they were carrying a single transposon identical to Tn6133. They harbored genes conferring resistance to several antibiotics (aminoglycosides, ß-lactams, macrolides, streptogramin B, tetracycline, and trimethoprim), and genes associated with virulence (enterotoxins, γ-hemolysins, and aureolysin). The present study can serve as baseline for further LA-MRSA epidemiological and evolutionary studies in Greece, while awareness and increased surveillance are needed to avoid their spread.

Genetic characterization of two methicillin-resistant Staphylococcus aureus spa type t127 strains isolated from workers in the dairy production chain in Greece.

Methicillin-resistant Staphylococcus aureus (MRSA) constitutes a constant threat for the public health. Aim of the present study was to analyse the whole genome sequences of two MRSA strains belonging to Staphylococcus protein A (spa) type t127 isolated from humans working in two distantly located dairy production farms in Greece.MRSA strains were isolated from the nasal cavity of a food handler in a milk industry in Epirus, northwestern Greece (E-MRSA), and a person working in a cattle farm in Thrace, northeastern Greece (T-MRSA). Whole genome sequences taken using next generation sequencing were analysed for resistance and virulence genes applying various bioinformatic tools.Both isolates were assigned to ST1-IVa-t127 type, and they were transferring genes conferring resistance to tetracycline, ß-lactams, and aminoglycosides; T-MRSA was carrying additional genes leading to macrolide, lincosamide and streptogramin B (MLSB) resistance. Both isolates were carrying three plasmid replicon types, rep5, rep7 and rep16, while T-MRSA harboured also rep10 and rep15. E-MRSA carried scn and sak genes which were absent from T-MRSA.In conclusion, the genetic characterization of two unrelated ST1-IVa-t127 MRSA strains isolated from humans in close contact with livestock in Greece can be used as basis for further epidemiological and evolutionary studies.

Synergistic, bacteriostatic effect of propolis and glycerol against Listeria monocytogenes in chocolate milk under refrigerated storage.

Propolis ethanolic extracts, with or without glycerol, were added into pasteurized, non-fat chocolate milk, which was artificially contaminated with Listeria monocytogenes. The addition of propolis ethanolic extracts dissolved into glycerol led to a definite anti-listerial effect in milk stored at 4 ℃, with both propolis concentrations tested (2 or 4 mg of dry propolis ethanolic extract per milliliter of chocolate milk) leading to inhibition of L. monocytogenes growth throughout 20 days of storage. The combined addition of propolis ethanolic extracts with glycerol was also effective in significantly reducing the rate of growth of L. monocytogenes in chocolate milk stored under improper (10 ℃) refrigeration storage conditions (more than five-fold increase in the generation time of L. monocytogenes compared to control trials). Finally, the combined addition of a deodorized propolis ethanolic extract with glycerol resulted in a significant anti-listerial effect upon storage of contaminated milk at 4 ℃ (more than three-fold increase in the generation time of L. monocytogenes compared to controls) and in a smaller anti-listerial effect upon milk storage at 10 ℃ (two-fold increase in the generation time of the pathogen compared to controls). Of note, chocolate milk containing deodorized propolis ethanolic extract and glycerol received a positive consumer acceptability score on the nine-point hedonic scale (median acceptability score of "7"). Hence, propolis may possess a promising role as a natural anti-listerial preservative in dairy drinks.

High-Throughput, Sequence-Based Analysis of the Microbiota of Greek Kefir Grains from Two Geographic Regions.

RESEARCH BACKGROUND: Kefir is a natural probiotic drink traditionally produced by milk fermentation using kefir grains. Kefir grains are composed of a complex population of bacteria and yeasts embedded in a polysaccharide-protein matrix. The geographic origin of kefir grains may largely influence their microbial composition and the associated kefir drink properties. Although the detailed bacterial composition of kefir grains from several geographic regions has been reported, to date, analogous data about the microbiome of Greek kefir are lacking. Hence, the aim of this study is to investigate the structure and the diversity of the bacterial community of Greek kefir grains. EXPERIMENTAL APPROACH: The bacterial community structure and diversity of two different kefir grains from distant geographic regions in Greece were examined via high-throughput sequencing analysis, a culture-independent metagenomic approach, targeting the 16S rRNA V4 variable region, in order to gain a deeper understanding of their bacterial population diversities. RESULTS AND CONCLUSIONS: Firmicutes (a phylum that includes lactic acid bacteria) was strikingly dominant amongst the identified bacterial phyla, with over 99% of the sequences from both kefir grains classified to this phylum. At the family level, Lactobacillaceae sequences accounted for more than 98% of the operational taxonomic units (OTUs), followed by Ruminococcaceae, Lahnospiraceae, Bacteroidaceae and other bacterial families of lesser abundance. Α relatively small number of bacterial genera dominated, with Lactobacillus kefiranofaciens being the most abundant in both kefir grains (95.0% of OTUs in kefir A and 96.3% of OTUs in kefir B). However, a quite variable subdominant population was also present in both grains, including bacterial genera that have been previously associated with the gastrointestinal tract of humans and animals, some of which are believed to possess probiotic properties (Faecalibacterium spp., Bacteroides spp., Blautia spp.). Differences among the bacterial profiles of the two grains were very small indicating a high homogeneity despite the distant geographic origin. NOVELTY AND SCIENTIFIC CONTRIBUTION: This is the first study to deeply explore and report on the bacterial diversity and species richness of Greek kefir.

Isolation and characterization of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) from milk of dairy goats under low-input farm management in Greece.

The presence of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in raw milk is a challenge for veterinarians and public health professionals. In this study, we investigated the presence and clonality of S. aureus and MRSA in milk of individual dairy goats with subclinical mastitis reared under the low-input farming system in Greece and determined the isolates' enterotoxin gene carriage and their ability to form biofilms. S. aureus was isolated from 162 out of the 559 milk samples examined (29 %) and one isolate per S. aureus-positive sample was further characterized. S. aureus isolates were very closely related even among farms of distant geographical regions. Nine S. aureus isolates carried a functional mecA gene and were classified as MRSA. The S. aureus protein A (spa) typing in the MRSA isolates showed that four belonged to spa type t127 (44.4 %), three to t2049 (33.3 %) and two to t7947 (22.2 %). The spa type t7947 is reported for the first time in Greece. The MRSA isolates originated from two very distantly located farms, one located in the island of Skopelos and the other in Central Macedonia. Four of the MRSA isolates carried the staphylococcal enterotoxin genes sea or sec. Most of the isolates (92 % of S. aureus and 77.8 % of the MRSA) possessed moderate or weak biofilm-formation ability. Raw milk from low-input goat herds may serve as a potential vector of antimicrobial-resistant S. aureus to raw-milk consumers.

The influence of a hurdle target point on the kinematics of the handspring vault approach run during training.

The aim of this study was to investigate if a visible target for the hurdle take-off would influence the onset of visual regulation and hurdle kinematics during the approach run. Ten elite male gymnasts (age 23.4 ± 4.9 years, height 1.68 ± 0.06 m, mass 63.3 ± 6.2 kg) performed six handspring vaults with a full approach run under two controlled conditions: (a) with a 5-cm white tape on the runway marking the last touchdown of the approach run and the commencement of the hurdle (tape condition-T) and (b) under the standard vaulting regulations (non-tape condition-NT). Spatiotemporal data of the approach run and the hurdle were collected by four stationary and one panning cameras (sampling rate 300 fps). Eight out of 10 gymnasts commenced regulation earlier under T than under NT. Under T condition, horizontal velocity (Vx to = 9.06 ± 0.41 m/s) and vertical velocity (V to = 9.35 ± 0.37 m/s) was significantly faster than under NT condition (Vx to = 8.85 ± 0.49 m/s; V to = 9.11 ± 0.47 m/s). Introducing a target for the hurdle facilitates an early onset of step regulation and significantly improves the kinematics of the hurdle.

Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in bulk tank milk, livestock and dairy-farm personnel in north-central and north-eastern Greece: Prevalence, characterization and genetic relatedness.

Recently, there has been an increased tendency towards raw-milk consumption, which may pose a consumer risk, due to the possible presence of human pathogenic microorganisms, such as Staphylococcus aureus and even methicillin-resistant S. aureus (MRSA). The prevalence of S. aureus and methicillin-resistant S. aureus (MRSA) was investigated in 40 dairy (cattle, sheep and goat) farms in northern Greece. S. aureus and MRSA were detected in 47.8% and 4.1% of the 387 samples (raw milk, farmers and animal samples) tested, respectively. Most (81.3%) of the MRSA isolates harbored the mecA gene, whereas the mecC or Panton-Valentine Leucocidin (PVL) genes were not detected. Seven spa types were identified, with t127 being the most prevalent. Spa type t034 (CC398) was isolated for the first time from livestock in Greece. Staphylococcal enterotoxin genes were detected in 93.8% of the MRSA isolates. The MRSA isolates were genetically diverse and were all capable of biofilm production. Our results confirm the lurking threat of MRSA in raw milk and dairy farms and suggest the need for surveillance programs starting at the farm level.

Prevalence, antimicrobial susceptibility and characterization of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus isolated from dairy industries in north-central and north-eastern Greece.

Staphylococcus aureus is an important cause of food intoxication, whereas methicillin-resistant S. aureus (MRSA) constitutes a serious public-health concern due to its ability to colonize and infect humans and animals. S. aureus and MRSA have often been isolated from milk and dairy products. The objectives of this study were to estimate the prevalence and the antimicrobial resistance of S. aureus and MRSA in four Greek dairy industries, to identify virulence factors of MRSA isolates and to describe their genetic diversity, in order to identify possible epidemiological links and evaluate the risk of MRSA dissemination to the community. S. aureus was isolated from 67 out of 305 (22.0%) dairy industry samples (bulk-tank milk, dairy products, employee nasal swabs and equipment/surface swabs). Almost all (99%) of the 227 corresponding S. aureus isolates (approximately 4 isolates per positive sample) were resistant to at least one antimicrobial and 22% were multi-drug resistant (MDR). MRSA were isolated from 11 different samples (3.6%) originating from three of the dairy plants. All MRSA isolates were capable of forming biofilms, while staphylococcal enterotoxin (SE) genes were detected in 91% of the MRSA isolates, with sec being the most frequent. All of the MRSA isolates harbored the mecA gene but the mecC and Pandon-Valentine leucocidin (PVL) genes were not detected. Pulse-Field Gel Electrophoresis (PFGE) analysis showed genetic diversity among the MRSA isolates and indicated clonal circulation in one of the dairy plants. Seven spa types were identified among the MRSA isolates with the most prevalent (t065) isolated only in one dairy plant. Certain spa types (t065, t337 and t3536) were isolated for the first time in Greece. The presence of MDR, biofilm-forming and enterotoxigenic MRSA strains in dairy plant facilities may lead to their dissemination to the community, but also to staphylococcal food poisoning, when conditions are favorable. The study's findings highlight the need for continuous monitoring of the dairy production chain, the need for re-evaluating the implemented cleaning and sanitizing processes and the adoption of preventive strategies in order to minimize public-health risks.

Inhibitory activity of propolis against Listeria monocytogenes in milk stored under refrigeration.

Propolis is a natural bee-product with documented antimicrobial properties in vitro. The objective of this study was to develop a protocol for adding propolis into milk and to determine whether the addition of propolis can confer anti-listerial activity during the storage of milk under optimal or improper refrigeration conditions. Upon dissolving propolis ethanolic extract (PEE) into glycerol, the PEE-glycerol mixture contained no visible insoluble particles and could be dispersed evenly into milk, without leaving any insoluble material. PEE, with or without glycerol, was added into extended shelf-life milk, artificially contaminated with Listeria monocytogenes. The addition of PEE dissolved into glycerol resulted in a pronounced and dose-dependent anti-listerial effect in milk stored at 4 °C, with the higher concentration tested (4 mg of dry PEE per mL of milk) resulting in complete inhibition of L. monocytogenes growth throughout 30 days of storage. The combination of PEE with glycerol was also effective in significantly reducing the growth rate of the pathogen in milk stored under improper refrigeration (10 °C). Based on a patented PEE-deodorization protocol, the addition of deodorized PEE into milk resulted in a product with average consumer acceptability. However, the PEE deodorization process resulted in reduction or even complete removal of propolis constituents with known antibacterial activity, with a concomitant significant reduction in its anti-listerial effect. Nonetheless, the data presented in this manuscript highlight the strong anti-listerial potential of propolis in milk and suggest that, upon further research on its deodorization and standardization, there may be room for the application of propolis as a natural preservative in dairy beverages.

Prevalence of Staphylococcus aureus and of methicillin-resistant S. aureus (MRSA) along the production chain of dairy products in north-western Greece.

The objective of this study was to estimate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the production chain of dairy products. Of 367 tested samples (36 bulk tank milk (BTM), 19 dairy products, 72 human, 185 animal, 55 equipment), 212 (57.8%) were found positive for S. aureus. Almost all isolates (99.6%) were resistant to at least one antimicrobial and 13.3% were multi-drug resistant (MDR), exhibiting resistance to three or more antibiotic classes. Eleven samples (3%) were found contaminated by MRSA carrying the mecA gene. None of the MRSA isolates carried the mecC or the Pandon-Valentine leucocidin (PVL) genes. Four spa types were identified among the MRSA isolates: t127, t3586, t1773, t4038, with t127 being the most prevalent (7 out of 11). Two of them, t3586 and t1773, were isolated for the first time in Greece. Furthermore, Pulse-Field Gel Electrophoresis (PFGE) analysis indicated clonal circulation through the dairy production chain. The presence of MDR S. aureus, and especially MRSA, in animals and dairy products represents a potential threat for the spread of this pathogen in the community. The results indicated that human, animal and environmental sources could be involved in the contamination of dairy products along their production chain and therefore further investigation of contamination sources is needed to control the dispersion of MRSA in the community.

Rapid ion-pair liquid chromatographic method for the determination of fenbendazole marker residue in fermented dairy products.

A simple, rapid and sensitive liquid chromatographic method that allows for the quantitative determination of fenbendazole residues in fermented dairy products is described. Samples were extracted with a mixture of acetonitrile-phosphoric acid and the extracts were defatted with hexane to be further partitioned into ethyl acetate. The organic layer was evaporated to dryness and the residue was reconstituted in mobile phase. Separation of fenbendazole and its sulphoxide, sulphone, and p-hydroxylated metabolites was carried out isocratically with a mobile phase containing both positively and negatively charged pairing ions. Overall recoveries ranged from 79.8 to 88.8%, while precision data, based on within and between days variations, suggested an overall relative standard deviation of 6.3-11.0%. The detection and quantification limits were lower than 9 and 21µg/kg, respectively. The method has been successfully applied to quantitate fenbendazole residues in Feta cheese and yoghurt made from spiked and incurred ovine milk.

Step characteristic interaction and asymmetry during the approach phase in long jump.

The aim of this study was to investigate the relative influence of step length (SL) and step frequency (SF) on step velocity (SV) during the approach run of high-level long jumpers and to quantify the asymmetry of these step characteristics. Spatiotemporal data of the approach run were collected during national competition from 10 long jumpers (age 26.2 ± 4.1 years, height 1.84 ± 0.06 m, mass 72.77 ± 3.23 kg, personal best performance 7.96 ± 0.30 m). Analyses were conducted for total approach, early approach and late approach. For the total approach 4/10 athletes were SF reliant and 6/10 athletes favoured neither characteristic. At the early approach, 3/10 athletes were SF reliant and 7/10 athletes favoured neither. During late approach 2/10 athletes demonstrated SL reliance, 7/10 athletes were SF reliant and 1/10 athletes favoured neither. Four athletes displayed significant asymmetry for SL and three for SF. However, no athletes demonstrated significant asymmetry for SV indicating that the asymmetrical demands of take-off do not have a marked influence on step characteristic asymmetry, probably due to the constraints of the event. Consideration should be given to the potentially conflicting demands between limbs for individual athletes.

Burnout syndrome and job satisfaction in Greek residents: exploring differences between trainees inside and outside the country.

BACKGROUND: The purpose of this study is to investigate the levels of burnout among Greek residents, highlighting potential differences between those practicing at home and abroad, as well as to investigate correlations with demographic, individual and labor factors. METHODS: The research was conducted on a sample of 131 residents, using an anonymous questionnaire which included demographic, individual and labor characteristics, Maslach's Burnout Inventory, questions regarding job and life satisfaction levels, working conditions and the impacts of the economic recession. RESULTS: Fifty two point seven percent of the sample were training in the Greek National Health Service (N.H.S.), 27.5% in Germany and 19.8% in the United Kingdom. One out of three residents in the Greek system showed high levels of burnout in all three dimensions of the syndrome, while 51.1%, 72.2% and 30.8% of the Greek, British and German team, respectively, appeared burnt out simultaneously in two dimensions. Levels of job and life satisfactions ranged on average, while workload appeared heavy. CONCLUSIONS: The occurrence of burnout was associated with gender, specialty, employment characteristics (working hours, autonomy, support etc.), proneness to accidents, country, job satisfaction and quality of life, but was not associated with age or marital status. No correlation was found with susceptibility to medical errors.

Successful surgical treatment of a complicated esophageal perforation, by use of primary closure and lung parenchyma reinforcement.

Esophageal perforation (EP) is a medical condition which demands urgent confrontation with significant complications. The cause of the perforation may be common, spontaneous or iatrogenic, with conservative or surgical therapeutic strategy, which is needed in the majority of incidents, depending on the characteristics of the lesion. We report a case of a 68-year-old man, with the existence of an ulcerative lesion 31 cm approximately from the dental barrier, and a coexistent stenosis, diagnosed through esophagogastroduodenoscopy, which evolved to an extensive purulent necrotic mediastinitis, diagnosed through a thorax CT scan after the patient began to complain of asphyxiation during eating. A right posterolateral thoracotomy was performed along with intensive wide spectrum antibiotic therapy. Primary closure of the perforation as well as pulmonary tenting was used with satisfactory results. There was no evidence of leakage after a 12-month "follow-up" period. The early diagnosis of an EP combined with immediate surgical procedure and frequent "follow-up" of the patient, eliminate the risks for the patient's life and ensure a satisfactory outcome.

Percutaneous tracheostomy-beware of the thyroidea-ima artery.

Percutaneous tracheostomy is a minimally invasive operation performed in patients, in order to provide an air passage through the windpipe. A rare cause of severe bleeding during such operation is the injury of the thyroidea-ima artery. This case report presents a patient with hemorrhage after thyroidea-ima injury during percutaneous dilatational tracheostomy. Surgeons should always be aware of such anatomic variation, in order to prevent urgent sternotomy.