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Quantitative MRI Helps to Repair Damaged Knees

By MedImaging International staff writers
Posted on 31 Jul 2009

Image: Colored magnetic resonance imaging (MRI) scan of the knee joint showing meniscus degeneration (Photo courtesy of Simon Fraser / SPL).

Investigators have shown that a biodegradable scaffold or plug can be used to treat patients with damaged knee cartilage. The study is unique in that it utilized serial magnetic resonance imaging (MRI) scanning and newer quantitative T2 mapping to examine how the plug incorporated itself into the knee.

The research findings were presented during the annual meeting of the American Orthopedic Society for Sports Medicine, June 9-12, 2009, in Keystone, CO, USA. "The data have been encouraging to support further evaluation of this synthetic scaffold as a cartilage repair technique,” said Asheesh Bedi, M.D., a fellow in sports medicine and shoulder surgery at the Hospital for Special Surgery (New York, NY, USA), who was involved with the study. Dr. Bedi performed analysis of MRI scans of patients primarily treated by Riley Williams, M.D., director of the Institute for Cartilage Repair at Hospital for Special Surgery. "The Trufit plug has been designed to have mechanical properties that are similar to cartilage and bone,” Dr. Bedi said.

Damage to so-called articular cartilage can occur in various ways, ranging from direct trauma in a motor vehicle accident to a noncontact, pivoting event on the soccer field. "Articular cartilage lacks the intrinsic properties of healing--you are essentially born with the articular cartilage that you have,” Dr. Bedi said. Left untreated, these injuries can increase loads placed on the remaining intact cartilage and increase the risk of progression to degenerative arthritis. One approach to treat patients with symptomatic chondral lesions is an OATS (osteoarticular transfer system) procedure, in which cartilage is transferred from one portion of the knee to treat another. Because this is a "robbing Peter to pay Paul” situation, researchers at Hospital for Special Surgery set out to evaluate whether they could use a biodegradable plug, the Trufit CB plug, to fill the donor site. The goal was to monitor how the plug incorporated itself into the knee and to assess the quality of the repair cartilage.

The Trufit plug has two layers. The top layer has properties similar to cartilage and the lower layer has properties similar to bone. The bilayered structure has mechanical properties that approximately match the adjacent cartilage and bone. Surgeons inserted the plug in the knees of 26 patients with donor lesions from OATS procedures and followed up with imaging studies (with MRI and T2-mapping) at various intervals for a period of 39 months.

"Quantitative MRI, when combined with morphologic assessment, allows us to understand the natural history of these repair techniques and define those patients who are most likely to benefit from the surgery,” said Hollis Potter, M.D., chief of the division of magnetic resonance imaging, director of research in the department of radiology and Imaging at Hospital for Special Surgery and lead author of the study. "We gain knowledge about the biology of integration with the host tissue, as well as the repair tissue biochemistry, all by a noninvasive imaging technique.”

"What we found was that the plug demonstrated a predictable process of maturation on imaging studies that paralleled the biology of their incorporation,” Dr. Bedi said. "With increasing postoperative duration, the repair tissue demonstrated encouraging properties with T2-values that resembled native articular cartilage.”

Dr. Williams, Dr. Bedi, and other surgeons at Hospital for Special Surgery are involved in ongoing studies to investigate the efficacy of the TruFit plug in treating primary cartilage defects as well. "What is unique about this study is that we have serial MRI with T2 mapping at various time points after surgery, which allows us to really examine the natural history of plug incorporation,” Dr. Bedi said.

Dr. Williams believes that there is a role for scaffold-based cartilage repair strategies in the treatment of symptomatic cartilage lesions. "It is our hope that we can successfully treat these cartilage problems over the long term, thus restoring normal knee function and slowing the progression of knee arthritis,” Dr. Williams said.

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58 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

59 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

60 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

61 (93.936920166016): 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 (673.77090454102): SELECT fid FROM jos_deeppockets WHERE id=294724673 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294724673 AND published='1' LIMIT 1

63 (462.05520629883): 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 (71.048736572266): select jos_twitters.link from jos_twitters where cat=10

65 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

66 (38.862228393555): select jos_google_plus.link from jos_google_plus where cat=10

67 (39.815902709961): select jos_linkedin.link from jos_linkedin where cat=10

68 (33.855438232422): SELECT fid FROM jos_deeppockets WHERE id=294724673 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294724673 AND published='1' LIMIT 1

69 (32.901763916016): 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 (325.91819763184): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (303.03001403809): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (62.942504882812): 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 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (60.796737670898): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (39.100646972656): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (37.193298339844): 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 (59.127807617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): 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 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

105 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

106 (50.783157348633): 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=294724673 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (82.015991210938): 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=294724673 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

110 (50.067901611328): 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=294724673 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (506.87789916992): 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=294724673 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (609.15946960449): 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 (410.07995605469): 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 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

115 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

116 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

117 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

118 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

119 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

120 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

121 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

122 (330.92498779297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 52263.021469116): 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 (!!!!! 1685.1425170898): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724673 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724673 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 19315.958023071): ( 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 (!!!!! 1181.1256408691): ( 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 (!!!!! 2613.0676269531): 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 (51.021575927734): 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 (313.04359436035): 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 (38.862228393555): 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 (247.95532226562): 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 (41.007995605469): 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 (314.95094299316): 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 (56.028366088867): 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 (549.0779876709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (466.82357788086): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (230.07392883301): SELECT name FROM jos_deeppockets WHERE id=212

138 (34.093856811523): SELECT name FROM jos_deeppockets WHERE id=212

139 (705.00373840332): 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 (564.8136138916): 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 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

142 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

143 (!!!!! 11142.96913147): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1713.0374908447): 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=294724673 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (185.01281738281): 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=294724673 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1425.02784729): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1096.0102081299): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

149 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

150 (!!!!! 1521.110534668): 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 (375.03242492676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

152 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

153 (!!!!! 2927.0648956299): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294724673 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294724673 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (73.909759521484): 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 (35.04753112793): 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 (39.815902709961): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2969.0265655518): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

158 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294724673 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294724673 AND published='1' LIMIT 1

159 (135.89859008789): select jos_twitters.link from jos_twitters where cat=10

160 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

161 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

162 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

163 (262.02201843262): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1919.9848175049): insert into jos_banners_delta values (14615,'2025-06-29 06:27:45','216.73.216.249','view'),(14202,'2025-06-29 06:27:45','216.73.216.249','view'),(14203,'2025-06-29 06:27:45','216.73.216.249','view')

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