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Orbital tuning is central for ice core chronologies beyond annual layer counting, available back to 60 ka (i.e. thousands of years before 1950) for Greenland ice cores. While several complementary orbital tuning tools have recently been developed using δ18Oatm, δO2⁄N2 and air content with different orbital targets, quantifying their uncertainties remains a challenge. Indeed, the exact processes linking variations of these parameters, measured in the air trapped in ice, to their orbital targets are not yet fully understood. Here, we provide new series of δO2∕N2 and δ18Oatm data encompassing Marine Isotopic Stage (MIS) 5 (between 100 and 160 ka) and the oldest part (340–800 ka) of the East Antarctic EPICA Dome C (EDC) ice core. For the first time, the measurements over MIS 5 allow an inter-comparison of δO2∕N2 and δ18Oatm records from three East Antarctic ice core sites (EDC, Vostok and Dome F). This comparison highlights some site-specific δO2∕N2 variations. Such an observation, the evidence of a 100 ka periodicity in the δO2∕N2 signal and the difficulty to identify extrema and mid-slopes in δO2∕N2 increase the uncertainty associated with the use of δO2∕N2 as an orbital tuning tool, now calculated to be 3–4 ka. When combining records of δ18Oatm and δO2∕N2 from Vostok and EDC, we find a loss of orbital signature for these two parameters during periods of minimum eccentricity (∼ 400 ka, ∼ 720–800 ka). Our data set reveals a time-varying offset between δO2∕N2 and δ18Oatm records over the last 800 ka that we interpret as variations in the lagged response of δ18Oatm to precession. The largest offsets are identified during Terminations II, MIS 8 and MIS 16, corresponding to periods of destabilization of the Northern polar ice sheets. We therefore suggest that the occurrence of Heinrich–like events influences the response of δ18Oatm to precession.

A recent coherent chronology has been built for four Antarctic ice cores and the NorthGRIP (NGRIP) Greenland ice core (Antarctic Ice Core Chronology 2012, AICC2012) using a Bayesian approach for ice core dating (Datice). When building the AICC2012 chronology, and in order to prevent any confusion with official ice core chronology, the AICC2012 chronology for NGRIP was forced to fit exactly the GICC05 chronology based on layer counting. However, such a strong tuning did not satisfy the hypothesis of independence of background parameters and observations for the NGRIP core, as required by Datice. We present here the implementation in Datice of a new type of markers that is better suited for constraints deduced from layer counting: the duration constraints. Estimating the global error on chronology due to such markers is not straightforward and implies some assumption on the correlation between individual counting errors for each interval of duration. We validate this new methodological implementation by conducting twin experiments and a posteriori diagnostics on the NGRIP ice core. Several sensitivity tests on marker sampling and correlation between counting errors were performed to provide some guidelines when using such a method for future dating experiments. Finally, using these markers for NGRIP in a five-core dating exercise with Datice leads to new chronologies that do not differ by more than 410 years from AICC2012 for Antarctic ice cores and 150 years from GICC05 for NGRIP over the last 60 000 years.

Polar ice cores provide exceptional archives of past environmental conditions. The dating of ice cores and the estimation of the age-scale uncertainty are essential to interpret the climate and environmental records that they contain. It is, however, a complex problem which involves different methods. Here, we present IceChrono1, a new probabilistic model integrating various sources of chronological information to produce a common and optimized chronology for several ice cores, as well as its uncertainty. IceChrono1 is based on the inversion of three quantities: the surface accumulation rate, the lock-in depth (LID) of air bubbles and the thinning function. The chronological information integrated into the model are models of the sedimentation process (accumulation of snow, densification of snow into ice and air trapping, ice flow), ice- and air-dated horizons, ice and air depth intervals with known durations, Δdepth observations (depth shift between synchronous events recorded in the ice and in the air) and finally air and ice stratigraphic links in between ice cores. The optimization is formulated as a least squares problem, implying that all densities of probabilities are assumed to be Gaussian. It is numerically solved using the Levenberg–Marquardt algorithm and a numerical evaluation of the model's Jacobian. IceChrono follows an approach similar to that of the Datice model which was recently used to produce the AICC2012 (Antarctic ice core chronology) for four Antarctic ice cores and one Greenland ice core. IceChrono1 provides improvements and simplifications with respect to Datice from the mathematical, numerical and programming point of views. The capabilities of IceChrono1 are demonstrated on a case study similar to the AICC2012 dating experiment. We find results similar to those of Datice, within a few centuries, which is a confirmation of both IceChrono1 and Datice codes. We also test new functionalities with respect to the original version of Datice: observations as ice intervals with known durations, correlated observations, observations as air intervals with known durations and observations as mixed ice–air stratigraphic links. IceChrono1 is freely available under the General Public License v3 open source license.

Ice cores are exceptional archives which allow us to reconstruct a wealth of climatic parameters as well as past atmospheric composition over the last 800 kyr in Antarctica. Inferring the variations in past accumulation rate in polar regions is essential both for documenting past climate and for ice core chronology. On the East Antarctic Plateau, the accumulation rate is so small that annual layers cannot be identified and accumulation rate is mainly deduced from the water isotopic composition assuming constant temporal relationships between temperature, water isotopic composition and accumulation rate. Such an assumption leads to large uncertainties on the reconstructed past accumulation rate. Here, we use high-resolution beryllium-10 (10Be) as an alternative tool for inferring past accumulation rate for the EPICA Dome C ice core, in East Antarctica. We present a high-resolution 10Be record covering a full climatic cycle over the period 269 to 355 ka from Marine Isotope Stage (MIS) 9 to 10, including a period warmer than pre-industrial (MIS 9.3 optimum). After correcting 10Be for the estimated effect of the palaeomagnetic field, we deduce that the 10Be reconstruction is in reasonably good agreement with EDC3 values for the full cycle except for the period warmer than present. For the latter, the accumulation is up to 13% larger (4.46 cm ie yr−1 instead of 3.95). This result is in agreement with the studies suggesting an underestimation of the deuterium-based accumulation for the optimum of the Holocene (Parrenin et al. 2007a). Using the relationship between accumulation rate and surface temperature from the saturation vapour relationship, the 10Be-based accumulation rate reconstruction suggests that the temperature increase between the MIS 9.3 optimum and present day may be 2.4 K warmer than estimated by the water isotopes reconstruction. We compare these reconstructions to the available model results from CMIP5-PMIP3 for a glacial and an interglacial state, i.e. for the Last Glacial Maximum and pre-industrial climates. While 3 out of 7 models show relatively good agreement with the reconstructions of the accumulation–temperature relationships based on 10Be and water isotopes, the other models either underestimate or overestimate it, resulting in a range of model results much larger than the range of the reconstructions. Indeed, the models can encounter some difficulties in simulating precipitation changes linked with temperature or water isotope content on the East Antarctic Plateau during glacial–interglacial transition and need to be improved in the future.

Glacial climate was characterised by two types of abrupt events. Greenland ice cores record Dansgaard–Oeschger events, marked by abrupt warming in-between cold, stadial phases. Six of these stadials appear related to major Heinrich events (HEs), identified from ice-rafted debris (IRD) and large excursions in carbon- and oxygen-stable isotopic ratios in North Atlantic deep sea sediments, documenting major ice sheet collapse events. This finding has led to the paradigm that glacial cold events are induced by the response of the Atlantic Meridional Overturning Circulation to such massive freshwater inputs, supported by sensitivity studies conducted with climate models of various complexities. These models also simulate synchronous Greenland temperature and lower-latitude hydrological changes. To investigate the sequence of events between climate changes at low latitudes and in Greenland, we provide here the first 17O-excess record from a Greenland ice core during Dansgaard–Oeschger events 7 to 13, encompassing H4 and H5. Combined with other ice core proxy records, our new 17O-excess data set demonstrates that stadials are generally characterised by low 17O-excess levels compared to interstadials. This can be interpreted as synchronous change of high-latitude temperature and lower-latitude hydrological cycle (relative humidity at the oceanic source of evaporation or change in the water mass trajectory/recharge) and/or an influence of local temperature on 17O-excess through kinetic effect at snow formation. As an exception from this general pattern, stadial 9 consists of three phases, characterised first by Greenland cooling during 550 ± 60 years (as shown by markers of Greenland temperature δ18O and δ15N), followed by a specific lower-latitude fingerprint as identified from several proxy records (abrupt decrease in 17O-excess, increase in CO2 and methane mixing ratio, heavier δD-CH4 and δ18Oatm), lasting 740 ± 60 years, itself ending approximately 390 ± 50 years prior to abrupt Greenland warming. We hypothesise that this lower-latitude signal may be the fingerprint of Heinrich event 4 in Greenland ice cores. The proposed decoupling between stable cold Greenland temperature and low-latitude climate variability identified for stadial 9 provides new targets for benchmarking climate model simulations and testing mechanisms associated with millennial variability.

An accurate and coherent chronological framework is essential for the interpretation of climatic and environmental records obtained from deep polar ice cores. Until now, one common ice core age scale had been developed based on an inverse dating method (Datice), combining glaciological modelling with absolute and stratigraphic markers between 4 ice cores covering the last 50 ka (thousands of years before present) (Lemieux-Dudon et al., 2010). In this paper, together with the companion paper of Veres et al. (2013), we present an extension of this work back to 800 ka for the NGRIP, TALDICE, EDML, Vostok and EDC ice cores using an improved version of the Datice tool. The AICC2012 (Antarctic Ice Core Chronology 2012) chronology includes numerous new gas and ice stratigraphic links as well as improved evaluation of background and associated variance scenarios. This paper concentrates on the long timescales between 120–800 ka. In this framework, new measurements of δ18Oatm over Marine Isotope Stage (MIS) 11–12 on EDC and a complete δ18Oatm record of the TALDICE ice cores permit us to derive additional orbital gas age constraints. The coherency of the different orbitally deduced ages (from δ18Oatm, δO2/N2 and air content) has been verified before implementation in AICC2012. The new chronology is now independent of other archives and shows only small differences, most of the time within the original uncertainty range calculated by Datice, when compared with the previous ice core reference age scale EDC3, the Dome F chronology, or using a comparison between speleothems and methane. For instance, the largest deviation between AICC2012 and EDC3 (5.4 ka) is obtained around MIS 12. Despite significant modifications of the chronological constraints around MIS 5, now independent of speleothem records in AICC2012, the date of Termination II is very close to the EDC3 one.

The deep polar ice cores provide reference records commonly employed in global correlation of past climate events. However, temporal divergences reaching up to several thousand years (ka) exist between ice cores over the last climatic cycle. In this context, we are hereby introducing the Antarctic Ice Core Chronology 2012 (AICC2012), a new and coherent timescale developed for four Antarctic ice cores, namely Vostok, EPICA Dome C (EDC), EPICA Dronning Maud Land (EDML) and Talos Dome (TALDICE), alongside the Greenlandic NGRIP record. The AICC2012 timescale has been constructed using the Bayesian tool Datice (Lemieux-Dudon et al., 2010) that combines glaciological inputs and data constraints, including a wide range of relative and absolute gas and ice stratigraphic markers. We focus here on the last 120 ka, whereas the companion paper by Bazin et al. (2013) focuses on the interval 120–800 ka. Compared to previous timescales, AICC2012 presents an improved timing for the last glacial inception, respecting the glaciological constraints of all analyzed records. Moreover, with the addition of numerous new stratigraphic markers and improved calculation of the lock-in depth (LID) based on δ15N data employed as the Datice background scenario, the AICC2012 presents a slightly improved timing for the bipolar sequence of events over Marine Isotope Stage 3 associated with the seesaw mechanism, with maximum differences of about 600 yr with respect to the previous Datice-derived chronology of Lemieux-Dudon et al. (2010), hereafter denoted LD2010. Our improved scenario confirms the regional differences for the millennial scale variability over the last glacial period: while the EDC isotopic record (events of triangular shape) displays peaks roughly at the same time as the NGRIP abrupt isotopic increases, the EDML isotopic record (events characterized by broader peaks or even extended periods of high isotope values) reached the isotopic maximum several centuries before. It is expected that the future contribution of both other long ice core records and other types of chronological constraints to the Datice tool will lead to further refinements in the ice core chronologies beyond the AICC2012 chronology. For the time being however, we recommend that AICC2012 be used as the preferred chronology for the Vostok, EDC, EDML and TALDICE ice core records, both over the last glacial cycle (this study), and beyond (following Bazin et al., 2013). The ages for NGRIP in AICC2012 are virtually identical to those of GICC05 for the last 60.2 ka, whereas the ages beyond are independent of those in GICC05modelext (as in the construction of AICC2012, the GICC05modelext was included only via the background scenarios and not as age markers). As such, where issues of phasing between Antarctic records included in AICC2012 and NGRIP are involved, the NGRIP ages in AICC2012 should therefore be taken to avoid introducing false offsets. However for issues involving only Greenland ice cores, there is not yet a strong basis to recommend superseding GICC05modelext as the recommended age scale for Greenland ice cores.

Air and water stable isotope measurements from four Greenland deep ice cores (GRIP, GISP2, NGRIP and NEEM) are investigated over a series of Dansgaard–Oeschger events (DO 8, 9 and 10), which are representative of glacial millennial scale variability. Combined with firn modeling, air isotope data allow us to quantify abrupt temperature increases for each drill site (1σ = 0.6 °C for NEEM, GRIP and GISP2, 1.5 °C for NGRIP). Our data show that the magnitude of stadial–interstadial temperature increase is up to 2 °C larger in central and North Greenland than in northwest Greenland: i.e., for DO 8, a magnitude of +8.8 °C is inferred, which is significantly smaller than the +11.1 °C inferred at GISP2. The same spatial pattern is seen for accumulation increases. This pattern is coherent with climate simulations in response to reduced sea-ice extent in the Nordic seas. The temporal water isotope (δ18O)–temperature relationship varies between 0.3 and 0.6 (±0.08) ‰ °C−1 and is systematically larger at NEEM, possibly due to limited changes in precipitation seasonality compared to GISP2, GRIP or NGRIP. The gas age−ice age difference of warming events represented in water and air isotopes can only be modeled when assuming a 26% (NGRIP) to 40% (GRIP) lower accumulation than that derived from a Dansgaard–Johnsen ice flow model.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The posterior minimally invasive spine surgery (MISS) approach-or the paraspinal muscle approach-for posterior spinal fusion and segmental instrumentation in adolescent idiopathic scoliosis (AIS) was first reported in 2011. It is less invasive than the traditionally used open posterior midline approach, which is associated with significant morbidity, including denervation of the paraspinal muscles, significant blood loss, and a large midline skin incision. The literature suggests that the MISS approach, though technically challenging and with a longer operative time, provides similar levels of deformity correction, lower intraoperative blood loss, shorter hospital stays, better pain outcomes, and a faster return to sports than the open posterior midline approach. Correction maintenance and fusion rates also seem to be equivalent for both approaches. This narrative review presents the results of relevant publications reporting on spinal segmental instrumentation using pedicle screws and posterior spinal fusion as part of an MISS approach. It then compares them with the results of the traditional open posterior midline approach for treating AIS. It specifically examines perioperative morbidity and radiological and clinical outcomes with a minimal follow-up length of 2 years (range 2-9 years).

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Pediatric osteoarticular infections (OAIs) are serious conditions that can lead to severe septic complications, prolonged morbidity with long-term impaired function, and perturbed subsequent bone development. Kingella kingae ( K. kingae ) is currently accepted as the predominant pathogen in pediatric OAIs, especially among 6-48 month olds. The present study aimed to identify clinical and biological markers that would refine the detection of patients with an OAI due to K. kingae . We retrospectively studied every consecutive case of pediatric OAI admitted to our institution over 17 years. Medical records were examined for patient characteristics such as temperature at admission, affected segment, and biological parameters such as white blood cell (WBC) count, left shift, platelet count (PLT), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The 247 patients included 52.2% males and 47.8% females and mean age was 18.5 ± 10 months old. Four patients were older than 48 months; none were younger than 6 months old. Mean temperature at admission was 37.4 ± 0.9 °C. Regarding biological parameters, mean WBC count was 12,700 ± 4180/mm 3 , left shift was only present in one patient, mean PLT was 419,000 ± 123,000/mm 3 , mean CRP was 26.6 ± 27.8 mg/L, and mean ESR was 35.0 ± 18.9 mm/h. Compared to the modified predictors of OAI defined by Kocher and Caird, 17.2% of our cases were above their cut-off values for temperature, 52.3% were above the WBC cut-off, 33.5% were above the ESR cut-off, and 46.4% were above the CRP cut-off. OAIs due to K. kingae frequently remain undetected using the classic biological parameters for investigating bacterial infections. As an addition to the predictors normally used (°C, WBC, CRP, and ESR), this study found that elevated platelet count was frequently present during OAIs caused by K. kingae . Although this biological characteristic was inconstant, its presence was highly significant and very suggestive of an invasive infection due to K. kingae .

Our understanding of pediatric osteoarticular infections (OAIs) has improved significantly in recent decades. Kingella kingae is now recognized as the most common pathogen responsible for OAIs in pediatric populations younger than 4 years old. Research has provided a better understanding of the specific types, clinical characteristics, biological repercussions, and functional outcomes of these infections. Hands and wrists are rarely infected, with few reports available in the literature. The present study aimed to examine this specific condition in a large patient cohort, explore the implications for each anatomical area using magnetic resonance imaging (MRI), and critically evaluate the evolution of therapeutic management.

Posterior spinal fusion and segmental spinal instrumentation using pedicle screws (PS) is the most used procedure to correct adolescent idiopathic scoliosis. Computed navigation, robotic navigation, and patient-specific drill templates are available, besides the first described free-hand technique. None of these techniques are recognized as the gold standard. This review compares the PS placement accuracy and misplacement-related complication rates achieved with the techniques mentioned above. It further reports PS accuracy classifications and anatomic PS misplacement risk factors. The literature suggests a higher PS placement accuracy for robotic relative to computed navigation and for the latter relative to the free-hand technique (misplacement rates: 0.4-7.2% versus 1.9-11% versus 1.5-50.7%) using variable accuracy classifications. The reported PS-misplacement-related complication rates are, however, uniformly low (0-1.4%) for every technique, while robotic and computed navigation induce a roughly fourfold increase in the patient's intraoperative radiation exposure relative to the free-hand technique with fluoroscopic implant positioning control. The authors, therefore, recommend dedicating robotic and computed navigation for complex deformities or revisions with altered landmarks, underline the need for a generally accepted PS accuracy classification, and advise against PS placement in grade 4 pedicles yielding higher misplacement rates (22.2-31.5%)., Competing Interests: The authors declare no conflicts of interest.

Purpose: We assessed the suitability of a low-cost, handheld, nonmydriatic retinograph, namely the Horus DEC 200, for diabetic retinopathy (DR) diagnosis. Two factors were considered: ease of image acquisition and image quality., Methods: One operator acquired fundus photographs from 54 patients using the Horus and AFC-330, a more expensive, nonportable retinograph. Satisfaction surveys were filled out by patients. Then, two retinologists subjectively assessed image quality and graded DR severity in one eye of each patient. Objective image quality indices also were computed., Results: During image acquisitions, patients had difficulty locating the fixation target inside the Horus: by default, 53.7% of them had to fixate external points with the contralateral eye, as opposed to none of them using the AFC-330 ( P < 0.0001). This issue impacted the duration of image acquisitions. Images obtained by the Horus were of significantly lower quality according to the experts ( P = 0.0002 and P = 0.0004) and to the objective criterion ( P < 0.0001). As a result, up to 20.4% of eyes were inadequate for interpretation, as opposed to 9.3% using the AFC-330. However, no significant difference was found in terms of DR severity according to both experts ( P = 0.557 and P = 0.156)., Conclusions: The Horus can be used to screen DR, but at the cost of longer examination times and higher proportions of patients referred to an ophthalmologist due to inadequate image quality., Translational Relevance: The Horus is adequate to screen DR, for instance in primary care centers or in mobile imaging units.

Purpose: We report a case of symptomatic circumscribed choroidal hemangioma (CCH) treated by photodynamic therapy (PDT) combined with injection of an intravitreal dexamethasone implant (IDI) (Ozurdex(®))., Case Report: A 39-year-old woman was referred to our outpatient clinic for a progressive decrease in vision of her right eye, measured at 20/25, due to subretinal exudation (SRE) associated with juxtapapillary CCH. Basal diameter of the CCH was 6mm, and its height was 2mm. Treatment consisted of injection of an IDI followed 15 days later by PDT with a single spot covering the tumor (intensity of 600 mW/cm(2) for 83 seconds [50 J/cm(2)]). Six weeks after PDT, we noted improvement of the vision to 20/20, complete resolution of SRE, and tumor flattening. No side-effects were observed. Anatomic and functional results remained unchanged over 9 months of follow-up., Conclusions: This case suggests that IDI (Ozurdex(®)) potentiates the effect of PDT with less risk of local side-effects than triamcinolone acetonide. Further evaluation of this protocol remains necessary. Nonetheless, combined treatment with injection of IDI followed 15 days later by PDT for the treatment of symptomatic CCH may prove to be a sound alternative to radiotherapy and may be more efficacious than PDT alone., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

A method for silica-coating at the nanoscale by electrophoretic deposition is presented here, using raw or grafted silica dispersions.