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AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

Diagnosis of Digestive Disease Impacted by Emerging Imaging Technologies

By MedImaging International staff writers
Posted on 20 Nov 2009

Preliminary findings from a multicenter study of detection rates for polyps and adenomas using a retrograde-viewing device for the colonoscope, known as the third eye retroscope (TER), found that endoscopists missed more polyps with the colonoscope alone than when using the TER with the colonoscope.

In a separate study, investigators found that the overall detection of both polyps and adenomas was improved with use of TER, particularly after the endoscopist had completed 15 procedures, suggesting a "learning curve.”

Recent advances in colonoscopic technology were featured in a number of studies presented at the annual scientific meeting of the American College of Gastroenterology, held October 2009 in New York, NY, USA. In this research, some technologies fared better than others did at improving detection of potentially precancerous growths in the colon known as adenomas.

The TER is a disposable device that is passed through the instrument channel of a conventional colonoscope to provide a retrograde view that complements the forward view of the colonoscopy during withdrawal of the scope from the colon, allowing a rearview or backwards look at the far side of the numerous anatomic folds and bends in the colon.

Dr. Peter Siersema, from the University Medical Center Utrecht (The Netherlands), reported interim findings from a randomized, controlled, prospective study of the effectiveness of the TER for increasing the diagnostic yield of colonoscopy. This preliminary analysis of 126 patients who underwent same-day back-to-back colonoscopy and colonoscopy with TER found that the relative risk of missing a lesion with colonoscopy versus TER was 2.57 for all polyps. "When endoscopists used the colonoscope alone, they missed 2.57 times more polyps then when the used the retrograde viewing device along with the colonoscope,” explained Dr. Siersema.

Dr. Daniel DeMarco, medical director of endoscopy at Baylor University Medical Center (Dallas, TX, USA), also presented interim data from a multicenter study involving 17 investigators at nine medical institutions in the United States looking at detection rates and withdrawal of the scope. The prospective study suggested that TER could lead to an enhancement of the detection rate of polyps and adenomas compared to standard colonoscopy. As endoscopists performed more procedures, their detection rates for both polyps and adenomas improved from earlier exams compared to later exams, and the withdrawal times for the later procedures were somewhat shorter than for the earlier procedures.

"Colonoscopy is the most accurate method for evaluating the colon, but some lesions can be missed, especially if they are on the proximal aspect of folds or flexures in the colon,” explained Dr. DeMarco. "This study evaluates the learning curve for use of the TER, both in terms of efficacy of detection of lesions and time-efficiency.”

High-definition (HD) colonoscopy has the potential to identify more polyps in the colon, but several different teams of researchers explored whether HD is better than standard "white light” colonoscopy at finding adenomas--benign growths in the colon that have the potential to become cancerous. High definition (HD) colonoscopes may allow detection of slight changes in the colonic mucosa, potentially aiding detection of adenomas and hyperplastic polyps.

Findings from a retrospective study of 720 patients at New York Presbyterian Hospital Weill-Cornell Medical Center (New York, NY, USA) demonstrated that while HD colonoscopy improves the overall detection of polyps compared to standard colonoscopy, there is no statistically significant difference in the total number of adenomas between the two types of exams.

The absolute polyp detection rate for high definition colonoscopy was 36.4 percent compared to 29.4% for conventional white light colonoscopy. However, when comparing the ability to detect adenomas, 53% of the polyps found in the HD GROUP were adenomas, compared to 46.7% of polyps in the standard white light group.

Researchers from the Mayo Clinic (Rochester, MN, USA) also compared adenoma detection using HD vs. standard white light colonoscopy. This retrospective study compared HD colonoscopy to standard white light colonoscopy in 2011 patients, 823 of whom were assigned to HD colonoscopy. The investigators reported that there was an increase in adenoma detection rate among the HD group (28.5%) compared to the standard white light group (23.4%) and that this finding was statistically significant. When the two techniques were compared in five consecutive subgroups, each of 164 patients, adenoma detection rates increased in both the HD and the standard white light groups over time. This increase in adenoma detection rate in both groups over the study period suggests a possible "learning effect” associated with the introduction of high definition colonoscopy.

A multicenter trial of high definition chromocolonoscopy conducted by Charles Kahi, M.D., of Indiana University (Bloomington, IN, USA) and colleagues found no overall increase in adenoma detection when compared to high definition white light colonoscopy. Dr. Kahi also looked at whether chromocolonoscopy improved detection of nonpolypoid growths in the colon, including flat or depressed lesions, which are an increasingly recognized precursor for colorectal cancer.

"Flat and depressed adenomas are inherently more difficult to visualize with standard colonoscopy, while being more likely to harbor high-grade dysplasia or invasive carcinoma than polypoid lesions, irrespective of size,” explained Dr. Kahi.

In the study that used high-definition colonoscopy, patients randomized to chromo-colonoscopy underwent pancolonic spraying with indigocarmine dye administered by a reusable spraying catheter via the colonoscope accessory channel. The study was performed by experienced examiners with interest in colonoscopy and colorectal cancer screening at four medical centers in the United States. Using high-definition colonoscopy, there was no increase in overall adenoma detection and only a modest increase in flat adenoma and small adenoma detection with indigocarmine chromocolonoscopy.

Related Links:
University Medical Center Utrecht

Baylor University Medical Center

Weill-Cornell Medical Center

Mayo Clinic

Indiana University

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54 (42.915344238281): 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 (72.002410888672): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (468.96934509277): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1209.9742889404): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

58 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

59 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

60 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

61 (114.91775512695): 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 (589.13230895996): SELECT fid FROM jos_deeppockets WHERE id=294726478 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726478 AND published='1' LIMIT 1

63 (343.08433532715): 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 (53.167343139648): select jos_twitters.link from jos_twitters where cat=10

65 (38.14697265625): select jos_facebook.link from jos_facebook where cat=10

66 (92.029571533203): select jos_google_plus.link from jos_google_plus where cat=10

67 (48.87580871582): select jos_linkedin.link from jos_linkedin where cat=10

68 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE id=294726478 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726478 AND published='1' LIMIT 1

69 (33.140182495117): 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 (317.09671020508): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (302.07633972168): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (40.054321289062): 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 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.994415283203): 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 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (59.843063354492): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (53.167343139648): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (47.922134399414): 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 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

105 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

106 (74.863433837891): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (66.995620727539): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

109 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

110 (59.127807617188): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (513.07678222656): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (556.94580078125): 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 (396.0132598877): 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 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

115 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

116 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

117 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

118 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

119 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

120 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

121 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

122 (200.98686218262): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 29591.083526611): 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 (786.06605529785): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726478 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726478 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9632.1105957031): ( 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 (92.983245849609): ( 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 (200.03318786621): 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 (35.04753112793): 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 (138.99803161621): 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 (31.948089599609): 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 (108.00361633301): 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 (30.994415283203): 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 (109.19570922852): 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 (29.802322387695): 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 (401.97372436523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (249.86267089844): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (151.8726348877): SELECT name FROM jos_deeppockets WHERE id=212

138 (33.855438232422): SELECT name FROM jos_deeppockets WHERE id=212

139 (544.07119750977): 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 (465.15464782715): 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 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

142 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

143 (!!!!! 8140.0871276855): TRUNCATE TABLE jos_trademed_module

144 (87.976455688477): 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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (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_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=294726478 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (833.98818969727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

149 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

150 (!!!!! 1157.9990386963): 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 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

152 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

153 (32.186508178711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726478 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726478 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (32.901763916016): 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 (52.928924560547): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (170.94612121582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

158 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726478 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726478 AND published='1' LIMIT 1

159 (98.943710327148): select jos_twitters.link from jos_twitters where cat=10

160 (27.894973754883): select jos_facebook.link from jos_facebook where cat=10

161 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

163 (241.99485778809): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (949.85961914062): insert into jos_banners_delta values (14615,'2025-06-28 19:56:41','216.73.216.249','view'),(14202,'2025-06-28 19:56:41','216.73.216.249','view'),(14203,'2025-06-28 19:56:41','216.73.216.249','view')

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