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fMRI Identifies Cognitive Abilities in Severely Brain-Injured Patients

By MedImaging International staff writers
Posted on 08 Mar 2012

Only by utilizing complex machine-learning techniques to decode repeated functional magnetic resonance imaging (fMRI) brain scans were investigators able to provide evidence that a patient with a severe brain injury could, in her way, communicate accurately.

Their study, published in the February 13, 2012, issue of the journal Archives of Neurology, demonstrates how hard it is to determine whether a patient can communicate using only measured brain activity, even if it is possible for them to generate effective patterns of brain activation in response to instructed commands. Patients in a minimally conscious state or who have locked-in syndrome (normal cognitive function with severe motor impairment) and can follow commands in the absence of a motor response may not generate distinctly interpretable communications using the same patterns of brain activity, according to the researchers, from NewYork-Presbyterian/Weill Cornell (New York, NY, USA).

While less advanced methods have been shown successful, the investigators reported that their new approach provides important new insights into brain function and level of consciousness. It also identifies processes of variation in brain activity supporting cognitive function after injury.

“In these studies we have reanalyzed earlier published data that demonstrated an effort to communicate using brain activations alone that apparently failed but was nonetheless a clear effort to generate a response,” said Dr. Nicholas D. Schiff, professor of neurology and neuroscience and professor of public health at Weill Cornel Medical College, and a neurologist at New York Presbyterian Hospital/Weill Cornell Medical Center. “Importantly, the reanalysis with new, more sensitive methods provides evidence that the problem with communication may reflect a mismatch of our expectations in designing the assessment, rather than a failure on the subject’s part in an attempt to accurately communicate with us.”

“Our study shows that multivariate, machine-learning methods can be useful in determining whether patients are attempting to communicate, specifically when applied to data that already show evidence of a signal in univariate, more standard methods of analysis,” remarked the study’s lead author, Jonathan Bardin, a fourth-year neuroscience graduate student at Weill Cornell Medical College. “It is our clinical and ethical imperative to learn as much as possible about their ability to communicate,” he said. “A simple bedside exam is not good enough.”

“We need a set of methods that are both powerful and simple, and we are not there yet, as this study shows,” added Dr. Schiff. “We are using quite complex tasks to perhaps detect just the few of many patients who are conscious.”

This study is a continuation of New York Presbyterian/Weill Cornell research into how fMRI can establish a line of communication with brain-injured patients to understand if they can benefit from rehabilitation, and to assess their level of pain and other clinical parameters that would improve care and quality of life.

It specifically follows up on a study published in the journal Brain February 2011 that demonstrated use of fMRI to detect consciousness in six patients (either locked-in or minimally conscious) resulted in a wide, and largely unpredictable, variation in the ability of patients to respond to a simple command (such as “imagine swimming--now stop”) and then using the same command to answer simple yes/no or multiple-choice questions. This variation was evident when compared with their ability to interact at the bedside using gestures or voice.

Some patients unable to communicate by gestures or voice were unable to do the mental tests, while others unable to communicate by gestures or voice were intermittently able to answer the researchers’ questions using mental imagery. Moreover, interestingly, some patients with the ability to communicate through gestures or voice were unable to do the mental tasks.

The researchers reported that these findings suggest that no imaging technology yet exists at this time that can effectively assess the higher-level functioning that may be, and indeed seems to be, occurring in a number of severely brain-injured patients. “There are people whose personal autonomy is abridged because they don’t have a good motor channel to express themselves despite, in some cases, having a clear mind and opinions and desires about themselves and the world,” Dr. Schiff remarked about those findings. “Not all minimally conscious patients are the same, and not all patients with locked-in syndrome are the same.”

This chief new finding of this study is a reworking of findings from a 25-year-old patient who was the only one of six who demonstrated an ability to use the fMRI signal for communication in the earlier research. But her results were puzzling because it seemed that she was consistently responding to the answer that was directly after the correct answer, according to Dr. Bardin. “It’s often seen in patients like this--she had a stroke that damaged her brain--that there can be a cognitive delay in some area of the brain. fMRI is a readout of blood flow instead of actual neural activity, so these delays could be caused by an interruption of blood flow due to damage or could just mean they are working on the problem more slowly, and the answer looks wrong because it is given in the next response period.”

To understand this, Mr. Bardin employed a newer technique, which he reported has come out of machine-learning research, to instruct a computer to evaluate multiple fMRI scans from the patient after she answered the two questions a number of times. This so-called multivariate approach used the same data collected for the first study, which, in the typical univariate analysis, specifically looks at functioning in the brain’s supplementary motor area (SMA), which is active when “normal” study participants imagine doing a task.

In contrast, the multivariate analysis evaluates whether there is a pattern of activity in any part of the brain that is consistent from one scan to the next. “When there is significant damage to the brain, it can rewire itself so that functions associated with SMA could be processed somewhere else,” Dr. Bardin said.

Using this complex application, the researchers found that is was evident that the patient had consistently attempted to communicate answers to both questions--but at a delayed speed.

The researchers noted that that one approach to analyze fMRI scans is not better than the other for all patients, and that univariate methods should always be performed first. Multivariate approaches can be particularly sensitive to noise, leading to false positives if used on their own. If the standard approach reveals a signal, the multivariate approach could be used to gain further insights and possibly identify response in patients where the univariate findings are ambiguous.

“We did all these things to simply show that we think this patient was trying to communicate,” Mr. Bardin said. “You have to be very careful in your data analysis before saying anything strongly about what a patient can or cannot do.”

“Rigid experimental paradigms like those used in the field can very well miss important information about these patients,” Dr. Schiff concluded. “This is all extremely complex and messy, but we should expect that. Given the injuries some of our patients suffer, their cognitive abilities are very difficult to detect behaviorally or through simplistic tests or scans.”

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51 (50.783157348633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

52 (401.97372436523): SELECT name FROM jos_deeppockets WHERE id=294739681 LIMIT 1

53 (296.11587524414): SELECT name FROM jos_deeppockets_archive WHERE id=294739681 LIMIT 1

54 (59.127807617188): 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 (128.98445129395): 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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (726.93824768066): 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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1101.016998291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

58 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

59 (308.03680419922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

60 (272.03559875488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

61 (546.93222045898): 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 (849.00856018066): SELECT fid FROM jos_deeppockets WHERE id=294739681 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739681 AND published='1' LIMIT 1

63 (602.00691223145): 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 (550.0316619873): select jos_twitters.link from jos_twitters where cat=10

65 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

66 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

67 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

68 (383.13865661621): SELECT fid FROM jos_deeppockets WHERE id=294739681 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739681 AND published='1' LIMIT 1

69 (41.007995605469): 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 (!!!!! 1524.9252319336): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (271.08192443848): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (49.114227294922): 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 (170.94612121582): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (293.01643371582): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (155.92575073242): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (188.11225891113): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (79.870223999023): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (345.94535827637): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (!!!!! 1020.9083557129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739681 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 (108.00361633301): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

105 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

106 (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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294739681 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=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

109 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

110 (54.836273193359): 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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (679.96978759766): 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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (609.8747253418): 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 (353.09791564941): 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 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

116 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

117 (141.85905456543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

118 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

119 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

120 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

121 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

122 (259.1609954834): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 19197.225570679): 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 (575.06561279297): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739681 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739681 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 6882.905960083): ( 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 (82.969665527344): ( 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 (229.1202545166): 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 (38.862228393555): 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 (152.1110534668): 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 (107.0499420166): 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 (146.86584472656): 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 (32.901763916016): 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 (124.21607971191): 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 (60.081481933594): 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 (361.91940307617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (261.06834411621): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (117.06352233887): SELECT name FROM jos_deeppockets WHERE id=212

138 (37.908554077148): SELECT name FROM jos_deeppockets WHERE id=212

139 (618.93463134766): 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 (468.01567077637): 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 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

142 (45.7763671875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

143 (!!!!! 8097.8870391846): 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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (57.93571472168): 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=294739681 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (777.9598236084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

149 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

150 (!!!!! 1066.9231414795): 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 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

152 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

153 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739681 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739681 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (32.186508178711): 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 (28.133392333984): 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 (!!!!! 6047.0104217529): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (376.93977355957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

158 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739681 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739681 AND published='1' LIMIT 1

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

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

161 (30.040740966797): 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 (263.92936706543): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1050.9490966797): insert into jos_banners_delta values (14615,'2025-06-26 14:10:41','216.73.216.249','view'),(14202,'2025-06-26 14:10:41','216.73.216.249','view'),(14203,'2025-06-26 14:10:41','216.73.216.249','view')

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