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MRI Simulation of Blood Flow Helps Plan Child's Delicate Heart Surgery enlarge

By MedImaging International staff writers
Posted on 22 Sep 2009

Researchers have developed a tool for virtual surgery that allows heart surgeons to view the predicted effects of different surgical approaches.

By manipulating three-dimensional (3D) cardiac magnetic resonance images (MRI) of a patient's specific anatomy, physicians can compare how alternative approaches affect blood flow and expected outcomes, and can select the best approach for each patient before entering the operating room. "This tool helps us to get the best result for each patient," said coauthor Mark A. Fogel, M.D., an associate professor of cardiology and radiology, and director of Cardiac MRI at The Children's Hospital of Philadelphia. "The team can assess the different surgical options to achieve the best blood flow and the optimum mixture of blood, so we can maximize the heart's energy efficiency."

In the August 2009 issue of the Journal of the American College of Cardiology: Cardiovascular Imaging, the researchers, from Georgia Institute of Technology (Georgia Tech; Atlanta, USA), collaborating with pediatric cardiologists and surgeons at the Children's Hospital of Philadelphia (PA, USA), described the surgical planning strategy, detailing how the tool helped them to plan the surgery of a four-year-old girl who was born with just one functional ventricle, or pumping chamber, instead of two.

Two in every 1,000 babies in the United States alone are born with this type of single ventricle heart defect. These children typically suffer from low levels of oxygen in their tissues because their oxygen-rich and oxygen-poor blood mix in their one functional ventricle before being redistributed to their lungs and body.

To correct this, the children undergo a series of three open-heart surgeries--called the staged Fontan reconstruction--to reshape the circulation in a way that allows oxygen-poor blood to flow from the limbs directly to the lungs without going through the heart. While these vascular modifications can eliminate blood mixing and restore normal oxygenation levels, surgeons and cardiologists must ensure that the lungs will receive proper amounts of blood and nutrients after the surgery so that normal development occurs.

"Preoperatively determining the Fontan configuration that will achieve balanced blood flow to the lungs is very difficult and the wide variety and complexity of patients' anatomies requires an approach that is very specific and personalized," said Ajit Yoganathan, Ph.D., a professor in the department of biomedical engineering at Georgia Tech and Emory University (Atlanta, GA, USA). "With our surgical planning framework, the physicians gain a better understanding of each child's unique heart defect, thus improving the surgery outcome and recovery time."

The patient described in this article, a girl, age four, from Staten Island, NY, USA, had previously undergone all three stages of the Fontan procedure at the Children's Hospital of Philadelphia, but developed severe complications. Her oxygen saturation was very low--only 72%, compared to normal levels of at least 95%--which indicated the possibility of abnormal connections between the veins and arteries in one of her lungs. Normally, the liver releases hormonal factors that prevent these abnormal connections, so the presence of the malformations indicated a low supply of hepatic blood to the lung.

To improve the distribution of these hormonal factors to both lungs, the surgeons needed to operate again and reconfigure the patient's cardiovascular anatomy. Georgia Tech's surgical planning framework helped Thomas L. Spray, M.D., chief of the division of cardiothoracic surgery at Children's Hospital, to determine the optimal surgical option. "MRI acquires images of the child's heart without using radiation," said Dr. Spray. "Then we use the computerized technology to model different connections to simulate optimum blood flow characteristics, before we perform the surgery."

The image-based surgical planning consisted of five major steps: acquiring MRI scans of the child's heart at different times in the cardiac cycle, modeling the preoperative heart anatomy and blood flow, performing virtual surgeries, using computational fluid dynamics to model the proposed postoperative flow, and measuring the distribution of liver-derived hormonal factors and other clinically relevant parameters as feedback to the surgeon.

Dr. Fogel collected three different types of magnetic resonance images, and Dr. Yoganathan, along with graduate students Kartik Sundareswaran and Diane de Zélicourt, generated a 3D model of the child's cardiovascular anatomy. From the model, they reconstructed the 3D preoperative flow fields to understand the underlying causes of the malformations.

For this particular patient, the team saw a highly uneven flow distribution--the left lung was receiving about 70% of the blood pumped out by the heart, but only 5% of the hepatic blood. Both observations suggested left lung malformations, but closer examination of the flow structures in that particular patient revealed that the competition between different vessels at the center of the original Fontan connection effectively forced all hepatic factors into the right lung even though a vast majority of total cardiac output went to the left lung.

To facilitate the design of the surgical options that would correct this problem, Jarek Rossignac, Ph.D., a professor in Georgia Tech's School of Interactive Computing, developed Surgem, an interactive geometric modeling environment that allowed the surgeon to use both hands and natural gestures in three-dimensions to grab, pull, twist, and bend a 3D computer representation of the patient's anatomy. After analyzing the 3D reconstruction of the failing cardiovascular geometry, the team considered three surgical options.

The research team then performed computational fluid dynamics simulations on all three options to investigate for each how well blood would flow to the lungs and the amount of energy required to drive blood through each connection design. These measures of clinical performance allowed the cardiologists and surgeons to conduct a risk/benefit analysis, which also included factors such as difficulty of completion and potential complications.

Of the three choices, Dr. Spray favored the option that showed a slightly higher energy cost but exhibited the best performance concerning hepatic factor distribution to the left and right lungs. Five months after the surgery, the young girl showed a dramatic improvement in her overall clinical condition and oxygen saturation levels, which increased from 72-94%. She is breathing easier and is now able to play actively like other children, according to her cardiologist, Donald Putman, M.D., of Staten Island.

"The ability to perform this work is a team effort," Dr. Fogel added. "State-of-the-art three-dimensional cardiac MRI married to modern biomedical engineering and applied anatomy and physiology enabled this approach. With the advanced pediatric cardiothoracic surgery we have here at The Children's Hospital of Philadelphia, patients can benefit from this new method."

Related Links:
Georgia Institute of Technology
Children's Hospital of Philadelphia

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53 (216.96090698242): SELECT name FROM jos_deeppockets_archive WHERE id=294725504 LIMIT 1

54 (87.976455688477): 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 (60.796737670898): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (437.97492980957): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1889.9440765381): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

58 (112.05673217773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

59 (218.15299987793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

60 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

61 (124.93133544922): 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 (596.04644775391): SELECT fid FROM jos_deeppockets WHERE id=294725504 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294725504 AND published='1' LIMIT 1

63 (278.94973754883): 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 (70.095062255859): select jos_twitters.link from jos_twitters where cat=10

65 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

66 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

67 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

68 (57.220458984375): SELECT fid FROM jos_deeppockets WHERE id=294725504 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294725504 AND published='1' LIMIT 1

69 (45.061111450195): 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 (228.8818359375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (193.83430480957): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (57.93571472168): 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 (78.916549682617): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (43.153762817383): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.014785766602): 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 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

105 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

106 (97.036361694336): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (75.101852416992): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

109 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

110 (107.0499420166): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (642.06123352051): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (629.18663024902): 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 (355.00526428223): 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 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

115 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

116 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

117 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

118 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

119 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

120 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

121 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

122 (205.99365234375): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 19915.103912354): 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 (414.84832763672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725504 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725504 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7482.0518493652): ( 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 (74.863433837891): ( 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 (63.180923461914): 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 (31.948089599609): 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 (46.014785766602): 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 (56.028366088867): 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 (260.1146697998): 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 (49.114227294922): 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 (35.04753112793): 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 (51.021575927734): 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 (361.20414733887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (282.04917907715): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (195.98007202148): SELECT name FROM jos_deeppockets WHERE id=212

138 (43.869018554688): SELECT name FROM jos_deeppockets WHERE id=212

139 (602.00691223145): 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 (570.77407836914): 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 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

142 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

143 (!!!!! 7776.9756317139): TRUNCATE TABLE jos_trademed_module

144 (98.943710327148): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (77.962875366211): 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=294725504 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (879.04930114746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

149 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

150 (!!!!! 1134.8724365234): 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 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

152 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

153 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725504 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725504 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (33.855438232422): 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 (31.948089599609): 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 (66.041946411133): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

158 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725504 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725504 AND published='1' LIMIT 1

159 (41.007995605469): select jos_twitters.link from jos_twitters where cat=10

160 (29.802322387695): select jos_facebook.link from jos_facebook where cat=10

161 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

163 (283.95652770996): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (939.84603881836): insert into jos_banners_delta values (14615,'2025-06-29 02:38:45','216.73.216.249','view'),(14202,'2025-06-29 02:38:45','216.73.216.249','view'),(14203,'2025-06-29 02:38:45','216.73.216.249','view')

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