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Imaging Tool Developed to Help Guide Pancreatic Cyst Treatment

By MedImaging International staff writers
Posted on 25 Mar 2010

A research team has developed an evaluation tool to help guide asymptomatic pancreatic cyst treatment.

Because of improved imaging technology, pancreatic cysts are increasingly diagnosed in asymptomatic individuals who undergo scans for other reasons. Moreover, while most of these cysts follow a benign course, a small but significant number are either malignant at the time of diagnosis or have the potential to develop into pancreatic cancer during a patient's lifetime.

The predicament for both patient and clinician is determining which cysts to leave alone and which to remove surgically. Existing treatment guidelines do not clearly address many treatment options beyond the removal of part of the pancreas--a major undertaking for an asymptomatic lesion.

Now, a University of California, Los Angeles (UCLA; USA)-Veterans Affairs research team has described their technology in the February 2010 issue of the journal Gastroenterology, describing how the tool takes into account overall health, age, cyst size, surgical risk, and patients' views about quality of life.

"Surgery may not be the best initial approach for all patients diagnosed with a specific pancreatic cyst. The new tool may help with decision-making and mapping out a treatment plan,” said study author Dr. Brennan Spiegel, director of the UCLA-VA Center for Outcomes Research and Education at the David Geffen School of Medicine at UCLA and the VA Greater Los Angeles Healthcare System.

The diagnosis of asymptomatic cysts has increased fivefold over the past decade, due partly to an aging population and to improved diagnostics. Current imaging techniques--including computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound, in which a small camera is inserted down the throat and into the stomach and small bowel to image the pancreas--combined with pancreatic cyst fluid analysis, offer 80% accuracy in cyst diagnosis.

"Pancreatic cysts are most often diagnosed in an older population, and although many are benign, these must be carefully tracked, since a small percentage can develop into pancreatic cancer,” said study author Dr. James J. Farrell, associate professor of digestive diseases at the Geffen School of Medicine and director of UCLA's Pancreatic Diseases Program.

Using decision-analysis software, the research team evaluated a set of hypothetical patients ranging in age from 65-85 with a variety of asymptomatic pancreatic cysts, ranging in size from 0.5 cm to greater than 3 cm and located in the head of the pancreas, the most common site for branch duct cysts.

The evaluation tool compared four competing treatment strategies: surgical removal of the cyst, annual noninvasive imaging surveillance with MRI or CT, yearly endoscopic ultrasound scan, and no treatment. While the tool takes into account patient age, health, cyst size, and surgical risk, it also considers whether the patient values overall survival, no matter the quality of life, or if the person prefers balancing quantity and quality of life by pursuing less invasive medical measures, which may lead to shorter survival but a better quality of life.

The researchers discovered that to increase overall survival, regardless of the quality of life, surgical removal was the dominant strategy for a cyst greater than 2 cm, in spite of the patient's age or other health issues--this is smaller than the 3 cm threshold supported by current treatment guidelines for surgical intervention. Surveillance was the dominant strategy for any cyst less than 1 cm, which is similar to current guidelines.

For patients focused on optimizing both quantity and quality of life, either the "do nothing” approach or a surveillance strategy appears optimal for those between the ages of 65 and 75 with cysts less than 3 cm. For patients over age 85, noninvasive surveillance dominated if quality of life was important, most likely because surgical benefits are often outweighed by the poor quality of life experienced postoperatively in this population.

"The evaluation tool offers greater insight into not only key risk factors for deciding pancreatic cyst treatment but also what patients want and value,” said study author Dr. Benjamin M. Weinberg, a gastroenterologist in the division of digestive diseases at UCLA's Geffen School of Medicine and the department of gastroenterology at the VA Greater Los Angeles Healthcare System.

The researchers noted that data on how to use the new evaluation tool are available in the study article, and that the tool is ready for use by clinicians. Future research focused on the further understanding the disease process, exploring the rate at which benign cysts turn malignant, and delineating the natural history of a malignant cyst that does not undergo treatment may also help improve management of pancreatic cysts, the researchers reported.

"We are learning more and more about the development and treatment of pancreatic cysts,” said study author Dr. James S. Tomlinson, assistant professor of surgical oncology at UCLA's Geffen School of Medicine and the department of surgery at the VA Greater Los Angeles Healthcare System. "The more prognostic tools available to assist both the clinician and the patient in the complex decision-making associated with cystic disease of the pancreas, the more appropriate the management of this disease.”

The researchers noted that current management of pancreatic cysts remains unclear and challenging. To date, no prospective randomized trials have been ocnducted for this disease. To optimize individual care, clinicians need evidence-based guidance to help select between competing strategies.

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56 (519.0372467041): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1507.9975128174): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

58 (174.04556274414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

59 (!!!!! 1964.0922546387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

60 (653.98216247559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 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 (374.07875061035): SELECT fid FROM jos_deeppockets WHERE id=294728641 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728641 AND published='1' LIMIT 1

63 (267.02880859375): 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 (60.081481933594): select jos_twitters.link from jos_twitters where cat=10

65 (26.941299438477): select jos_facebook.link from jos_facebook where cat=10

66 (29.087066650391): select jos_google_plus.link from jos_google_plus where cat=10

67 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

68 (29.087066650391): SELECT fid FROM jos_deeppockets WHERE id=294728641 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728641 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 (152.8263092041): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (138.99803161621): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (44.107437133789): 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 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (47.922134399414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (26.941299438477): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (31.948089599609): 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 (!!!!! 4258.1558227539): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (80.108642578125): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

105 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

106 (60.081481933594): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (48.160552978516): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

109 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

110 (109.91096496582): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (502.10952758789): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (697.85118103027): 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 (710.96420288086): 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 (324.96452331543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

115 (191.92695617676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

116 (177.14500427246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

117 (140.90538024902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

118 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

119 (182.15179443359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

120 (180.95970153809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

121 (155.92575073242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

122 (316.85829162598): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 65849.06578064): 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 (600.81481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728641 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728641 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 13764.85824585): ( 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 (69.141387939453): ( 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 (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

128 (32.901763916016): 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 (41.961669921875): 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 (330.92498779297): 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 (38.14697265625): 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 (33.855438232422): 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 (30.994415283203): 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 (496.14906311035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (509.97734069824): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (252.96211242676): SELECT name FROM jos_deeppockets WHERE id=212

138 (65.088272094727): SELECT name FROM jos_deeppockets WHERE id=212

139 (526.90505981445): 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 (439.88227844238): 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 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

142 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

143 (!!!!! 9046.0777282715): TRUNCATE TABLE jos_trademed_module

144 (80.108642578125): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (56.982040405273): 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=294728641 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (882.86399841309): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

149 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

150 (!!!!! 1154.899597168): 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 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

152 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

153 (36.954879760742): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728641 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728641 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (29.087066650391): 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 (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)

156 (30.040740966797): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

158 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728641 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728641 AND published='1' LIMIT 1

159 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

160 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

161 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

162 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

163 (280.14183044434): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (968.21784973145): insert into jos_banners_delta values (14615,'2025-06-28 13:14:29','216.73.216.249','view'),(14202,'2025-06-28 13:14:29','216.73.216.249','view'),(14203,'2025-06-28 13:14:29','216.73.216.249','view')

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