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

High Altitude Climbers at Risk for Brain Hemorrhage

By MedImaging International staff writers
Posted on 25 Dec 2012

Image: The images show magnetic resonance (MR) slices through the brains of two mountaineers. The image on the left is from a mountaineer who climbed to altitudes above 7,000 meters, and the one on the right is from a mountaineer who survived a high altitude cerebral edema (HACE). The arrows point to the corpus callosum. This part of the corpus callosum is normal in the left image, whereas in the right image (HACE survivor) it shows black spots representing multiple small hemorrhages (microhemorrhages) (Photo courtesy of RSNA/Dr. Knauth et al, University Hospital Gottingen).

New magnetic resonance imaging (MRI) research has demonstrated that mountain climbers who experience a specific type of high-altitude illness called high altitude cerebral edema (HACE) have evidence of brain bleeding years after the initial incident.

The new research was presented in November 2012 at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago (IL, USA). HACE is a severe and frequently lethal disorder that can affect mountain climbers, skiers, hikers, and travelers at high altitudes—typically higher than 2,300 meters.

HACE results from swelling of brain tissue caused by leakage of fluids from the capillaries. Symptoms include headache, loss of coordination, and decreasing levels of consciousness. “HACE is a life-threatening condition,” said Michael Knauth, MD, PhD, from the University Medical Center’s department of neuroradiology (Gottingen, Germany). “It usually happens in a hostile environment where neither help nor proper diagnostic tools are available.”

Dr. Knauth and colleagues from the University Hospitals in Gottingen and Heidelberg (Germany), compared brain MRI scans among four groups of mountaineers: climbers with a history of high altitude illness; climbers with well documented episodes of HACE; climbers with a history of severe acute mountain sickness (AMS); and climbers with a history of isolated high altitude pulmonary edema (HAPE), a life-threatening accumulation of fluid in the lungs that occurs at high altitudes. Two neuroradiologists evaluated the brain MRI findings without knowing the status of the mountaineers and assigned a score based on the number and location of any microhemorrhages. “In most cases, these microhemorrhages are so small that they are only visible with a special MRI technique called susceptibility-weighted imaging,” Dr. Knauth said. “With this technique, the microhemorrhages are depicted as little black spots.”

The MRI scans revealed brain microhemorrhages almost exclusively in HACE survivors. Of the 10 climbers with a history of HACE, eight had evidence of microhemorrhages on MRI. The other two had uncertain results. Only two of the remaining 26 climbers were positive for microhemorrhages. “It was previously thought that HACE did not leave any traces in the brains of survivors,” Dr. Knauth said. “Our studies show that this is not the case. For several years after, microhemorrhages or microbleeds are visible in the brains of HACE survivors.”

Survivors of the most clinically severe cases of HACE had the most noticeable traces of microhemorrhages on MRI scans. The hemorrhages were found chiefly in the corpus callosum, the thick band of nerve fibers that connects the left and right halves of the brain, and revealed a characteristic distribution different from other vascular diseases such as vasculitis (blood vessel inflammation). “The distribution of microhemorrhages is a new and sensitive MRI sign of HACE and can be detected years after HACE,” Dr. Knauth said. “We will further analyze our clinical and MRI data on patients with acute mountain sickness, which is thought to be a precursor of HACE.”

Meanwhile, Dr. Knauth does not believe HACE survivors need to give up climbing. “We cannot give such a strong recommendation,” he said. “However, mountaineers who have already experienced HACE once should acclimatize to the altitude very slowly.”

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58 (119.20928955078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

59 (195.02639770508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

60 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

61 (157.11784362793): 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 (858.06846618652): SELECT fid FROM jos_deeppockets WHERE id=294743969 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743969 AND published='1' LIMIT 1

63 (379.08554077148): 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 (85.115432739258): select jos_twitters.link from jos_twitters where cat=10

65 (44.107437133789): select jos_facebook.link from jos_facebook where cat=10

66 (43.869018554688): select jos_google_plus.link from jos_google_plus where cat=10

67 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

68 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE id=294743969 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743969 AND published='1' LIMIT 1

69 (46.014785766602): 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=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (247.95532226562): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (54.836273193359): 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 (90.122222900391): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (74.863433837891): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (87.976455688477): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (45.061111450195): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (53.167343139648): 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 (190.97328186035): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (95.129013061523): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (59.127807617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (108.00361633301): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (135.18333435059): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (71.048736572266): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (45.7763671875): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (183.10546875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

105 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

106 (91.075897216797): 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=294743969 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (81.062316894531): 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=294743969 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (189.06593322754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

109 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

110 (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.id=294743969 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (737.90550231934): 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=294743969 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (934.83924865723): 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 (!!!!! 1154.1843414307): 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 (165.93933105469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

115 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

116 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

117 (272.98927307129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

118 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

119 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

120 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

121 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

122 (!!!!! 1100.0633239746): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 145537.85324097): 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 (!!!!! 21111.965179443): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743969 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743969 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 46185.01663208): ( 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 (!!!!! 4232.1681976318): ( 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 (!!!!! 4967.9279327393): 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 (!!!!! 3662.109375): 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 (585.79444885254): 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 (657.08160400391): 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 (!!!!! 1285.0761413574): 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 (653.02848815918): 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 (612.02049255371): 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 (!!!!! 1504.8980712891): 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 (657.08160400391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (801.08642578125): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (574.11193847656): SELECT name FROM jos_deeppockets WHERE id=212

138 (355.00526428223): SELECT name FROM jos_deeppockets WHERE id=212

139 (!!!!! 1223.087310791): 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 (910.99739074707): 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 (!!!!! 17708.06312561): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

142 (!!!!! 6305.9329986572): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

143 (!!!!! 39352.893829346): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 10478.019714355): 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=294743969 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 11953.830718994): 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=294743969 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 7490.1580810547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 27333.974838257): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2766.1323547363): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

149 (!!!!! 1265.0489807129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

150 (!!!!! 4161.1194610596): 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 (977.99301147461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

152 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

153 (!!!!! 1662.015914917): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743969 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743969 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (54.121017456055): 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 (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)

156 (!!!!! 1699.2092132568): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (511.88468933105): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

158 (211.00044250488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743969 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743969 AND published='1' LIMIT 1

159 (408.88786315918): select jos_twitters.link from jos_twitters where cat=10

160 (49.114227294922): select jos_facebook.link from jos_facebook where cat=10

161 (450.13427734375): select jos_google_plus.link from jos_google_plus where cat=10

162 (745.05805969238): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 3233.9096069336): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 7408.1420898438): insert into jos_banners_delta values (14615,'2025-06-25 20:30:04','216.73.216.120','view'),(14202,'2025-06-25 20:30:04','216.73.216.120','view'),(14203,'2025-06-25 20:30:04','216.73.216.120','view')

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