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

MRI Can Help Guide Therapy in Patients with Unclear-Onset Stroke

By MedImaging International staff writers
Posted on 10 Mar 2011

Among patients who have had strokes but who are not certain when symptoms began, magnetic resonance imaging (MRI) can help differentiate who might benefit from clot-busting agents while facing acceptable risk.

The study's findings were presented in February at the American Stroke Association's International Stroke Conference 2011, held in Los Angeles, CA, USA. Researchers used magnetic resonance imaging (MRI) techniques to screen 430 patients with unclear-onset stroke at six university hospitals in South Korea. Strokes are categorized as unclear-onset, or "wake-up,” strokes if patients or witnesses do not know when symptoms began, or woke up already in the throes of a stroke.

This is a major issue because clot-busting drugs have proven effective at reducing disability up to 4.5 hours after symptom onset. "Wake-up, or unclear-onset, strokes account for a quarter of all ischemic strokes but have been automatically excluded from clot-busting techniques because the onset time cannot be known. Our study shows that such patients could also be treated safely and effectively,” said Dong-Wha Kang, MD, PhD, lead author and associate professor in the department of neurology at Asan Medical Center at the University of Ulsan College of Medicine (Seoul, South Korea).

All the patients arrived at one of six emergency rooms within six hours of detecting symptoms. Using diffusion-perfusion MRI, which shows tissue death and blood flow in the brain, the investigators looked for sizable areas where tissue remained alive even though it lacked blood flow. To limit the risk of serious bleeding in the brain from clot-busting therapy, patients were excluded if they had extensive tissue death in the brain area supplied by a major artery, the middle cerebral artery, or if other MRI techniques, such as those called fluid attenuation inversion recovery (FLAIR) or T2, showed that the time of tissue death had elapsed.

More than 80 patients (median age 67 and classified as having severe stroke) were found eligible for clot-busting therapy, which included intravenous administration of the drug tissue plasminogen activator (tPA), direct administration of the drug urokinase to the blocked vessels in the brain or both. Some patients also had their clots removed mechanically or underwent stenting.

Among those who received the drug therapy, approximately 45% had at least a "good” clinical outcome--ranging from no symptoms to slight disability with curtailed activities--on the modified Rankin scale, which measures level of impairment and its impact on stroke patients' daily activities. Almost 29% had an excellent clinical outcome, meaning they were able to carry out all their usual activities with little or no impairment.

A key limitation of the study is that it did not include a comparison group of patients who did not receive the clot busting treatment. Still, Dr. Kang said, "This study should trigger follow-up studies to develop the best available treatment strategies for this important but neglected group of stroke patients.”

The study also found that female patients were likely to fare more poorly with treatment, as were patients who had a more severe initial evaluation of their stroke impairment, and those treated at the two centers lacking earlier experience in thrombolysis for unclear-onset stroke. Because researchers in the study treated patients with strokes of various origins, it is likely that the findings would also apply to non-Korean populations, according to Dr. Kang. But patient outcomes are likely to differ among medical centers, because of the availability of MRI facilities as well as interventionists to deliver clot-busting drugs directly to the brain blood vessels.

This work received the Emergency Medicine Award from the International Stroke Conference committee, which recognizes outstanding research in the field by a young investigator.

The researcher's next plan to compare the outcomes from their study population with those of comparable but untreated patients listed in stroke registries. "Although this study provides some important clues to treat wake-up, or unclear-onset, stroke patients, we still have a long way to go to find the best way to treat them,” Dr. Kang concluded.

Related Links:
University of Ulsan College of Medicine

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58 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

59 (207.90100097656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

60 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

61 (129.93812561035): 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 (664.94941711426): SELECT fid FROM jos_deeppockets WHERE id=294733803 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733803 AND published='1' LIMIT 1

63 (548.12431335449): 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 (68.187713623047): select jos_twitters.link from jos_twitters where cat=10

65 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

66 (38.14697265625): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

68 (54.836273193359): SELECT fid FROM jos_deeppockets WHERE id=294733803 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294733803 AND published='1' LIMIT 1

69 (51.021575927734): 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 (423.90823364258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (415.08674621582): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (55.074691772461): 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 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (39.100646972656): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.961669921875): 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 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

105 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

106 (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 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=294733803 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (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=294733803 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

109 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

110 (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.id=294733803 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (643.01490783691): 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=294733803 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (728.13034057617): 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 (498.77166748047): 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 (152.1110534668): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

115 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

116 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

117 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

118 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

119 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

120 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

121 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

122 (398.15902709961): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 27498.006820679): 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 (672.1019744873): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733803 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733803 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9975.1949310303): ( 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 (87.02278137207): ( 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 (47.922134399414): 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 (39.100646972656): 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 (51.021575927734): 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 (36.001205444336): 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 (356.91261291504): 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 (46.014785766602): 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 (43.869018554688): 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 (40.054321289062): 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 (416.99409484863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (330.92498779297): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (180.00602722168): SELECT name FROM jos_deeppockets WHERE id=212

138 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=212

139 (730.03768920898): 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 (773.90670776367): 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 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

142 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

143 (!!!!! 10493.993759155): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1747.8466033936): 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=294733803 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (83.92333984375): 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=294733803 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (516.17622375488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (493.04962158203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (211.95411682129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

149 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

150 (!!!!! 3553.1520843506): 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 (100.85105895996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

152 (94.175338745117): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

153 (50.067901611328): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294733803 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294733803 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (40.054321289062): 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 (36.954879760742): 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 (42.915344238281): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (130.17654418945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

158 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294733803 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294733803 AND published='1' LIMIT 1

159 (54.836273193359): select jos_twitters.link from jos_twitters where cat=10

160 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

161 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 1188.9934539795): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1197.0996856689): insert into jos_banners_delta values (14615,'2025-06-27 10:54:35','216.73.216.249','view'),(14202,'2025-06-27 10:54:35','216.73.216.249','view'),(14203,'2025-06-27 10:54:35','216.73.216.249','view')

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