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MR-Guided, Focused Ultrasound Deep Brain Treatment Effective for Essential Tremor

By MedImaging International staff writers
Posted on 20 Oct 2011

Preliminary results of a clinical trial indicated that magnetic resonance (MR)-guided focused ultrasound has the potential to control essential tremor (ET) safely and effectively. ET, a common neurologic disorder, affects 10 million people in the United States alone.

Results from the study’s first 10 patients revealed a 78% improvement in contralateral tremor scores in the hand, as assessed with the clinical rating scale for tremor (CRST). Patients’ functional activities scores improved by 92%, as assessed in the “disability” subsection of the CRST. Outcomes and complications were comparable to other procedures for tremor, including stereotactic thalamotomy and deep brain stimulation.

The study’s findings were presented at the Congress of Neurological Surgeons October 4, 2011, held in Washington DC, USA, by University of Virginia (UVA; Charlottesville, VA, USA) neurosurgeon W. Jeffrey Elias, MD. “So far, this noninvasive treatment has been life-changing for patients,” said Dr. Elias, the study’s lead investigator and director of stereotactic and functional neurosurgery at UVA. “All now have improved ability to use their dominant hand to perform tasks that they couldn’t do before treatment, such as writing legibly, drinking, and eating without spilling, and buttoning clothes. It has been exciting to see their immediate improvements.”

The study is using magnetic resonance imaging to guide and monitor the delivery of focused ultrasound to tremor-causing nerve cells in the thalamus, a region deep within the brain known to be an effective target for ET and other movement disorders. The treatment aim is to reduce tremor in a patient’s dominant hand.

Most study participants have had ET for decades, Dr. Elias reported. As part of the study’s inclusion criteria, all had previously taken at least two medications that did not control their tremor. In spite of the severity of their disability, patients had chosen to deal with symptoms rather than undergo invasive surgical procedures.

Conducted under a US Food and Drug Administration (FDA)-approved protocol, the single-arm, nonrandomized, phase 1 study began in February 2011 and is expected to treat 15 patients before concluding. All patients are being followed for three months. If final results prove successful, Elias anticipates launching a larger, pivotal trial to study the overall safety and long-term efficacy of MR-guided focused ultrasound in treating medication-refractory ET.

Funding for the study is being provided by the Focused Ultrasound Surgery Foundation (Charlottesville, VA, USA), which is also underwriting a similar study at the University of Toronto in Canada. Foundation chairman, Neal Kassell, MD, reported that the study’s success could lead to other new treatments. “By demonstrating that MR-guided focused ultrasound can treat tissue deep in the brain with great precision and accuracy, we hope to open the door to treating Parkinson’s disease, epilepsy, and brain tumors. Much work remains to be done, but the path forward is clear,” he observed. Because the brain poses more complex technical challenges than other organs, success in treating ET will spur advancements in developing new focused ultrasound therapies for the breast, liver, pancreas, and prostate, which are less complicated to treat.”

Currently, MR-guided focused ultrasound is an FDA-approved therapy for uterine fibroids; it is approved in Europe and elsewhere for the treatment of uterine fibroids and pain associated with bone metastasis. Around the world, clinical trials are treating prostate, breast, bone, and uterine tumors.

The UVA study marks the first step in determining if MR-guided focused ultrasound is a safe and effective treatment for ET and if it offers potential benefits beyond current surgical options. The study has enrolled patients who are 18 to 80 years old and who have taken at least two medications that do not control their tremor. Participants, who are followed for three months after treatment, receive assessments for general health, neurologic status, and tremor measurements. The study is also monitoring data about device or procedure-related side effects that occur within three months of treatment.

Study treatments are performed using the ExAblate Neuro, an investigational device manufactured by InSightec, Ltd. (Tirat Carmel, Israel). The device consists of a customized table with a helmet-like unit that contains phased array focused ultrasound transducers. Treatments are planned with the precision of MR imaging and then monitored with MR thermography, which provides real-time tracking of focused ultrasound delivery. The entire process is noninvasive and does not involve ionizing radiation.

During the study, a series of focused ultrasound pulses are administered through a patient’s intact scalp and skull to a precisely targeted spot in the thalamus. Patients receive no anesthesia and remain awake, providing feedback to clinicians after each pulse. Under the UVA study protocol, only one side of the brain is being treated known as a unilateral thalamotomy resulting in single hand tremor control.

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56 (524.04403686523): 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1342.0581817627): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

58 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

59 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

60 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

61 (97.990036010742): 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 (588.89389038086): SELECT fid FROM jos_deeppockets WHERE id=294737685 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737685 AND published='1' LIMIT 1

63 (369.07196044922): 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 (50.067901611328): select jos_twitters.link from jos_twitters where cat=10

65 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

66 (32.186508178711): select jos_google_plus.link from jos_google_plus where cat=10

67 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

68 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294737685 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737685 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 (362.15782165527): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (297.78480529785): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737685 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 (74.863433837891): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (301.83792114258): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (46.968460083008): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (34.093856811523): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.968460083008): 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 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (40.769577026367): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

105 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (67.949295043945): 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

109 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

110 (61.988830566406): 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (610.1131439209): 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1518.0110931396): 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 (597.00012207031): 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 (216.00723266602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

115 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

116 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

117 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

118 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

119 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

120 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

121 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

122 (512.12310791016): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 25773.048400879): 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 (659.94262695312): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737685 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737685 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8563.9953613281): ( 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 (128.98445129395): ( 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 (59.127807617188): 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 (40.054321289062): 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 (56.982040405273): 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 (312.80517578125): 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 (33.140182495117): 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 (31.948089599609): 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 (557.18421936035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (459.90943908691): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (287.77122497559): SELECT name FROM jos_deeppockets WHERE id=212

138 (50.067901611328): SELECT name FROM jos_deeppockets WHERE id=212

139 (717.1630859375): 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 (682.11555480957): 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 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

142 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

143 (!!!!! 20349.979400635): TRUNCATE TABLE jos_trademed_module

144 (388.86070251465): 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (211.00044250488): 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=294737685 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1388.0729675293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (88.214874267578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

149 (157.83309936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

150 (!!!!! 1596.9276428223): 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 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

152 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

153 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737685 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737685 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (28.848648071289): 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 (27.179718017578): 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 (!!!!! 3267.0497894287): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

158 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737685 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737685 AND published='1' LIMIT 1

159 (42.200088500977): select jos_twitters.link from jos_twitters where cat=10

160 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

161 (27.179718017578): select jos_google_plus.link from jos_google_plus where cat=10

162 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

163 (318.05038452148): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1100.7785797119): insert into jos_banners_delta values (14615,'2025-06-26 20:53:03','216.73.216.249','view'),(14202,'2025-06-26 20:53:03','216.73.216.249','view'),(14203,'2025-06-26 20:53:03','216.73.216.249','view')

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