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More Powerful CT Scans Help Identify Clogged Arteries

By MedImaging International staff writers
Posted on 12 Jan 2009

In a development that researchers reported likely to quash concerns about the value of expensive computed tomography (CT) scans to diagnose coronary artery blockages, an international team of researchers revealed strong evidence that the newer, more powerful 64-CT scans can easily and accurately identify people with major blood vessel disease and is nearly as accurate as invasive coronary angiography.

Reporting in The New England Journal of Medicine (NEJM) online November 26, 2008, issue, researchers at nine medical centers reported that the faster, 64-CT scans were 93% as precise as invasive, conventional imaging, better known as cardiac catheterization and virtually 100% accurate in detecting individuals with at least one artery dangerously clogged by the buildup of cholesterol and plaque.

Comparison of CT and catheterization results also demonstrated for the first time that they were equally effective in patients with heart attack symptoms, such as chest pain and shortness of breath, for predicting the need for cardiac bypass surgery or angioplasty to restore their blood flow. The CT scans accurately predicted 84% of invasive procedures performed, and catheterization predicted 82%

Senior study investigator and Johns Hopkins University (Baltimore, MD, USA; www.jhu.edu) cardiologist João Lima, M.D., noted that 64-CT scans are not a substitute for catheterization, but the scans, which take between five and 10 seconds to perform, are "an alternative diagnostic tool” physicians can use to "rule in or rule out” coronary blockages when other, more indirect tests for reduced blood flow, such as cardiac stress testing, are unclear or unsafe for a particular patient.

Cardiac catheterization, which also checks the function of heart valves and muscle, takes longer, between 30 minutes and 45 minutes to perform, and requires more than an hour for recovery. Potential complications from the invasive procedure include infection, heart attack, and stroke; however, these events are rare.

Dr. Lima, a professor of medicine and radiology at The Johns Hopkins University School of Medicine and its Heart and Vascular Institute, reported that the 64-CT scans, first introduced to the United States and tested at Hopkins in 2005, could reduce as much as one-fifth of the 1.3 million cardiac catheterizations performed each year nationwide that show no blockages.

CT scans for heart disease, although not yet covered by many private health plans in the United States, could also serve as an alternative to cardiac stress testing, which generally cannot safely be performed on the weak and elderly because the test uses hard exercise to speed up blood flow and measure heart function.

According to Dr. Lima, earlier studies had shown that older, less powerful 16-CT scans were only one-quarter to one-third as precise as the newer tests, "fuelling much heated debate as to whether or not use of the technology could ever be justified. But our latest findings weigh heavily in favor of the more advanced 64-CT scans,” he added, citing additional study results showing that the scans could pinpoint with 91% certainty the precise artery blocked. At four times the strength of the more widely available 16-CT scanner, Dr. Lima stated that the 64-CT scans "provided our first real view of the whole picture of what is going on in the artery, precisely where the blockage is, even if it is only a partially obstructed.”

Lead study investigator and interventional cardiologist Julie Miller, M.D., reported that the advanced scanners are so good that physicians can for the first time measure blockages in blood vessels as small as 1.5 mm in diameter. Older 16-CT scanners, according to Dr. Miller, are best suited for looking inside bigger arteries, those greater in diameter than 2 mm.

Each of the 291 men and women, all over the age of 40, selected to participate in the new study were already scheduled to have cardiac catheterization to check for blocked arteries. Every participant had a 64-CT scan prior to catheterization and was then monitored through regular check-ups, starting in 2005 and set to continue through 2009, to identify who developed or did not develop any heart problems, who required subsequent bypass surgery or angioplasty, and who did not need any procedure.

Researchers found that 90% of the patients without any major blockages were correctly diagnosed with 64-CT scans. The disadvantages of using 64-CT, according to Dr. Miller, are radiation exposure and the rare potential in some people to have an allergic reaction or to develop kidney problems resulting from the contrast dyes injected into the body to enhance the images. "CT technology has come a long way in the last decade,” said Dr. Miller, the leader of angiographic research and an assistant professor at Hopkins. She cited improvements that cut the average amount of radiation exposure and time required for a CT scan to less than 20 millisieverts with 16-CT scanners (which took about 12 seconds to perform), on average, to less than 15 millisieverts with 64-CT devices (at close to 6 seconds), and less than 6 millisieverts with the 320-CT (at less than one second).

Dr. Miller reported that the cost of the newer CT scanning--approximately US$700--compares favorably with that of current nuclear stress testing for reduced blood flow, in which radioactive dyes are used to detect arterial clogs, at nearly $1,000.

In cardiac catheterization, a thin tube is threaded into a blood vessel in the groin area to the heart's arteries, where a dye is released to produce a clear X-ray image of the beating heart and its arterial blood supply. The procedure typically costs in excess of $1,500.

Dr. Miller pointed out that early detection of blockages is critical to preempting a heart attack, allowing time for drug therapy, angioplasty, or heart bypass surgery to be used to keep arteries open. According to Dr. Lima, the investigators next steps are head-to-head comparison studies using either CT or nuclear stress testing, which measures reduced blood flow in areas of the heart to reveal clogging arteries. Included in the next study will be scans performed using an even more advanced scanner, the 320-CT. The latest imaging device was also evaluated at Johns Hopkins in 2006, and it can obtain images in less than a second, with considerable reductions in radiation exposure.

According to researchers, nearly 5,000 64-CT scanners are installed worldwide, but not all of the centers are equipped to perform and read cardiac CT scans. Dr. Miller noted that special training and certification are required by technicians and physicians to accurately perform, read, and interpret the scanned images. The American Heart Association and the American College of Cardiology Foundation in 2005 jointly established training guidelines.

The CT scanner used in the study was an Aquilion 64 multidetector CT scanner, manufactured by Toshiba Medical Systems (Tokyo, Japan).

The study's findings were presented in December 2008 at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago, IL, USA.

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49 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

50 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

51 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

52 (155.21049499512): SELECT name FROM jos_deeppockets WHERE id=294721652 LIMIT 1

53 (159.97886657715): SELECT name FROM jos_deeppockets_archive WHERE id=294721652 LIMIT 1

54 (53.882598876953): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

55 (61.03515625): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (308.03680419922): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1510.8585357666): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

58 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

59 (942.94548034668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

60 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

61 (157.11784362793): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (808.0005645752): SELECT fid FROM jos_deeppockets WHERE id=294721652 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294721652 AND published='1' LIMIT 1

63 (365.01884460449): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (454.90264892578): select jos_twitters.link from jos_twitters where cat=10

65 (69.141387939453): select jos_facebook.link from jos_facebook where cat=10

66 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

67 (168.0850982666): select jos_linkedin.link from jos_linkedin where cat=10

68 (265.12145996094): SELECT fid FROM jos_deeppockets WHERE id=294721652 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294721652 AND published='1' LIMIT 1

69 (40.054321289062): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (959.87319946289): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (330.92498779297): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.100646972656): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (238.18016052246): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (319.00405883789): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (196.93374633789): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (286.10229492188): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (180.00602722168): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (265.12145996094): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (84.877014160156): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (164.03198242188): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (190.01960754395): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (120.87821960449): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (452.04162597656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (33.140182495117): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1963.8538360596): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

105 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

106 (53.882598876953): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1096.0102081299): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

109 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

110 (289.9169921875): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (509.97734069824): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (749.11117553711): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (607.96737670898): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (157.83309936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

115 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

116 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

117 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

118 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

119 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

120 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

121 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

122 (294.92378234863): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 20119.905471802): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (568.15147399902): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721652 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721652 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 14883.995056152): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (218.86825561523): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (!!!!! 1099.1096496582): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (!!!!! 5236.8640899658): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (350.9521484375): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (47.922134399414): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (277.99606323242): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (216.00723266602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (33.140182495117): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (428.91502380371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (360.96572875977): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (179.05235290527): SELECT name FROM jos_deeppockets WHERE id=212

138 (126.12342834473): SELECT name FROM jos_deeppockets WHERE id=212

139 (637.05444335938): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (641.1075592041): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (115.15617370605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

142 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

143 (!!!!! 15333.890914917): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1087.9039764404): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (93.936920166016): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294721652 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (578.88031005859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

149 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

150 (!!!!! 1718.0442810059): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

152 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

153 (61.03515625): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721652 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721652 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2206.0871124268): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (76.055526733398): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (62.942504882812): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1031.8756103516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

158 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721652 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721652 AND published='1' LIMIT 1

159 (77.962875366211): select jos_twitters.link from jos_twitters where cat=10

160 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

161 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

162 (39.100646972656): select jos_linkedin.link from jos_linkedin where cat=10

163 (374.07875061035): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1224.9946594238): insert into jos_banners_delta values (14615,'2025-06-30 02:36:10','216.73.216.249','view'),(14202,'2025-06-30 02:36:10','216.73.216.249','view'),(14203,'2025-06-30 02:36:10','216.73.216.249','view')

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