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Study Shows How to Reduce Unnecessary MRI Tests for Stroke Detection and Improve Safety

By MedImaging International staff writers
Posted on 07 Oct 2009

In a small "proof of principle” study, stroke researchers have found that a simple, one-minute eye movement exam performed at the bedside worked better than a magnetic resonance imaging (MRI) scan to differentiate new strokes from other less serious disorders in patients complaining of dizziness, nausea, and spinning sensations.

Results of the study of 101 patients, who were already at higher than normal risk of stroke because of factors including high blood pressure or high cholesterol, were published online ahead of print on September 17, 2009, in the journal Stroke. The patients were all seen at OSF St. Francis Medical Center (Peoria, IL, USA).

The project, led by a Johns Hopkins University (JHU; Baltimore, MD, USA) neurologist in collaboration with colleagues at the University of Illinois in Peoria (USA; http://illinois.edu), found that the fast, extremely low-cost exam caught more strokes than the current gold standard of MRI, suggesting that if additional research on broader populations validates these findings, physicians may have a way to improve care and avoid the high costs of MRI in some cases. "The idea that a bedside exam could outperform a modern neuroimaging test such as MRI is something that most people had given up for dead, but we've shown it's possible,” said David E. Newman-Toker, M.D., Ph.D., assistant professor of neurology at the Johns Hopkins University School of Medicine.

Dizziness is a common medical problem, according to Dr. Newman-Toker, responsible for 2.6 million emergency room (ER) visits annually in the United States. While the vast majority of dizziness complaints are caused by benign inner-ear balance problems, about 4% are signals of stroke or transient ischemic attack (TIA, a condition that frequently warns of impending stroke in the coming days or weeks). Because more than half of patients with dizziness who are experiencing strokes show none of the classic stroke symptoms--one-sided weakness, numbness, or speech problems--emergency room physicians are estimated to misdiagnose at least one-third of them, losing the chance for quick and effective treatment.

"We know that time is brain, so when patients having a stroke are sent home erroneously, the consequences can be really serious, including death or permanent disability,” said Jorge C. Kattah, M.D., chairman of neurology at OSF St. Francis Medical Center, who co-led the study.

The study of eye movement tests was suggested by earlier research showing that people experiencing a stroke have eye-movement alterations that correlate with stroke-damage to various brain areas and that these are distinct from eye-movement alterations seen with benign ear diseases. Some patients, for example, cannot immediately adjust their eye position if their heads are quickly turned to the side, or they experience jerky eye movements as they try to focus on a doctor's finger when looking to either side.

Dr. Newman-Toker and his colleagues at the University of Illinois College of Medicine in Peoria speculated whether testing eye movements in dizzy patients might help them sort out which ones were having a stroke from those with other problems.

All of the patients in the current study were seen after complaining of severe dizziness that had lasted for several hours continuously, and all had at least one risk factor for stroke. The researchers chose them to increase the chance that they would find strokes in this population. None of the patients had a history of previous dizzy spells and more than half sought care at the Peoria medical center's ER, although some were inpatients at the hospital or were transferred from other area hospitals.

The researchers gave each patient an exam comprised of three eye-movement tests: looking for inability to keep the eyes stable as patients heads were rotated rapidly to either side, looking for jerkiness as patients tracked a doctor's finger to look right and left, and checking eye position to see if one eye was higher than the other. Each patient then received an early MRI scan, the highest-quality neuroimaging test available to confirm stroke in dizzy patients. Patients with eye tests suggesting stroke but without stroke on the first MRI scan underwent a repeat scan.

In the end, 69 patients were diagnosed with stroke and 25 with inner-ear conditions. The remainder had other neurologic problems. Using only the three eye-movement tests, the researchers had correctly diagnosed all of the strokes and 24 of 25 with inner-ear conditions. By contrast, initial MRI scans were falsely negative in 8 of the 69 stroke patients, who were later correctly diagnosed with follow-up MRI scanning.

Although the researchers emphasize the need to verify their results in a larger and more general population of patients with dizziness, Dr. Newman-Toker noted that the initial findings are "incredibly promising.” If they hold true, he added, testing eye movements could have several advantages over MRI beyond effective diagnostics. For example, while the wait time for an MRI can be several hours or more, physicians can perform all three eye-movement tests in a minute or less. Moreover, the eye-movement tests are "basically free,” compared to US$1,000 or more for an MRI scan, Dr. Newman-Toker stated.

"In an era where cost containment is butting up against issues of quality in health care delivery, there's tremendous potential for bedside approaches like ours that could reduce costs while improving quality at the same time,” concluded Dr. Newman-Toker.

Related Links:
Johns Hopkins University
University of Illinois in Peoria
OSF St. Francis Medical Center

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55 (257.01522827148): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (535.01129150391): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1117.9447174072): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

58 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

59 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

60 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

61 (76.055526733398): 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 (535.96496582031): SELECT fid FROM jos_deeppockets WHERE id=294725787 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294725787 AND published='1' LIMIT 1

63 (294.20852661133): 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 (55.074691772461): select jos_twitters.link from jos_twitters where cat=10

65 (28.848648071289): select jos_facebook.link from jos_facebook where cat=10

66 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

68 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE id=294725787 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294725787 AND published='1' LIMIT 1

69 (31.948089599609): 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 (280.14183044434): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (246.04797363281): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (37.908554077148): 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 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725787 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 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

105 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

106 (51.021575927734): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (51.021575927734): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

109 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

110 (68.902969360352): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (594.8543548584): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (767.94624328613): 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 (!!!!! 4729.0325164795): 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 (!!!!! 3383.1596374512): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

115 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

116 (99.18212890625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

117 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

118 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

119 (57.220458984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

120 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

121 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

122 (417.94776916504): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 60575.008392334): 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 (!!!!! 1188.0397796631): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725787 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725787 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 17302.989959717): ( 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 (53.167343139648): ( 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 (219.10667419434): 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 (36.001205444336): 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 (169.99244689941): 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 (35.04753112793): 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 (149.01161193848): 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 (35.04753112793): 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 (119.92454528809): 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 (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

135 (344.99168395996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (277.04238891602): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (204.08630371094): SELECT name FROM jos_deeppockets WHERE id=212

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

139 (530.00450134277): 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 (633.00132751465): 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 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

142 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

143 (!!!!! 8753.0612945557): TRUNCATE TABLE jos_trademed_module

144 (118.97087097168): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (66.041946411133): 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=294725787 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (786.06605529785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

149 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

150 (!!!!! 1304.1496276855): 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 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

152 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

153 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725787 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725787 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (27.894973754883): 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 (26.941299438477): 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 (34.093856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1068.8304901123): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

158 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725787 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725787 AND published='1' LIMIT 1

159 (152.1110534668): select jos_twitters.link from jos_twitters where cat=10

160 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

161 (28.133392333984): select jos_google_plus.link from jos_google_plus where cat=10

162 (26.941299438477): select jos_linkedin.link from jos_linkedin where cat=10

163 (301.12266540527): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (924.11041259766): insert into jos_banners_delta values (14615,'2025-06-29 01:26:38','216.73.216.249','view'),(14202,'2025-06-29 01:26:38','216.73.216.249','view'),(14203,'2025-06-29 01:26:38','216.73.216.249','view')

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