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MRI Scans Show Indications of Brain Injuries Not Seen in CT Scans

By MedImaging International staff writers
Posted on 07 Jan 2013

Magnetic resonance imaging (MRI) scanning at the hospital may be better at predicting long-term outcomes for individuals with mild traumatic brain injuries than computed tomography (CT), the customary modality for assessing such injuries in the emergency room, according to recent findings.

The study’s findings were published online December 7, 2012, in the journal Annals of Neurology. Led by the University of California, San Francisco (UCSF; USA) neuroradiologist Esther Yuh, MD, PhD, the study, called the US National Institutes of Health (NIH)-funded TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury), tracked 135 individuals treated for mild traumatic brain injuries over the past two years at one of three city hospitals with level-one trauma centers: San Francisco General Hospital (SFGH), the University of Pittsburgh Medical Center (PA, USA), and University Medical Center Brackenridge (Austin, TX, USA).

All 135 patients with mild traumatic brain injuries underwent CT scanning when they were first admitted, and all were given MRI scan about a week later. Most of them (99) had no detectable signs of injury on a CT scan, but more than one-fourth (27/99) who had a “normal” CT scans also had detectable areas on their MRI scans called “focal lesions,” which are indications of microscopic bleeding in the brain.

Identifying these focal lesions helped the doctors predict whether the patients were likely to endure persistent neurologic difficulties. Approximately 15% of people who have mild traumatic brain injuries do suffer long-term neurologic problems, however clinicians currently have no definitive way of predicting whether any one patient will or not. “This work raises questions of how we’re currently managing patients via CT scan,” said the study’s senior author Geoff Manley, MD, PhD, the chief of neurosurgery at SFGH and vice-chair of the department of neurological surgery at UCSF. “Having a normal CT scan doesn’t, in fact, say you’re normal.”

The US Centers for Disease Control and Prevention estimates that far more mild traumatic brain injuries may occur each year in the United States but the real number is not known because only injuries severe enough to bring someone to an emergency room are counted. Most of those who do show up at emergency rooms are treated and released without being admitted to the hospital. Typically, most people with mild traumatic brain injuries fully recover, but approximately one in six develop persistent, sometimes permanent, disability.

The difficulty, according to Dr. Manley, is that there is no way to tell which patients are going to have the poor long-term outcomes. Various socioeconomic factors can help predict prolonged disability, but until now, there were no validated imaging modalities, or blood tests for predicting how well or how quickly a patient will recover. Neither is there an agreement on how to treat mild traumatic brain injuries. “The treatment’s all over the place--if you’re getting treatment at all,” Dr. Manley said. The new study, according to the researchers, is a significant step closer toward finding a more quantitative method of assessing patients with mild traumatic brain injuries and developing more precision medical tools to identify, track, and treat them, he added.

If physicians knew which patients were at risk of greater disabilities, they could be tracked more carefully. The ability to identify patients at risk of long-term consequences would also hasten the development of new drugs because it would allow the identification of patients who would benefit the most from treatment and enhance their ability to evaluate potential new drugs in clinical trials.

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60 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

61 (60.081481933594): 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 (478.02925109863): SELECT fid FROM jos_deeppockets WHERE id=294744103 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744103 AND published='1' LIMIT 1

63 (278.94973754883): 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 (74.863433837891): select jos_twitters.link from jos_twitters where cat=10

65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (42.200088500977): select jos_google_plus.link from jos_google_plus where cat=10

67 (29.802322387695): select jos_linkedin.link from jos_linkedin where cat=10

68 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294744103 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744103 AND published='1' LIMIT 1

69 (30.994415283203): 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 (254.86946105957): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (210.04676818848): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (43.153762817383): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (28.848648071289): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.186508178711): 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 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

105 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

106 (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 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=294744103 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): 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=294744103 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

110 (46.968460083008): 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=294744103 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (450.84953308105): 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=294744103 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (510.93101501465): 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 (344.99168395996): 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 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

115 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

116 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

117 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

118 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

119 (36.001205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

120 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

121 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

122 (237.22648620605): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 27397.871017456): 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 (488.9965057373): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744103 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744103 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 16033.172607422): ( 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 (56.028366088867): ( 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 (35.04753112793): 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 (29.087066650391): 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 (49.829483032227): 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 (33.855438232422): 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 (262.97569274902): 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 (35.04753112793): 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 (29.087066650391): 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 (422.95455932617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (299.93057250977): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (236.98806762695): SELECT name FROM jos_deeppockets WHERE id=212

138 (103.95050048828): SELECT name FROM jos_deeppockets WHERE id=212

139 (837.80288696289): 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 (473.97613525391): 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 (!!!!! 1492.0234680176): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

142 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

143 (!!!!! 11908.054351807): 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=294744103 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (62.942504882812): 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=294744103 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (816.10679626465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

149 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

150 (!!!!! 1111.0305786133): 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 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

152 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

153 (58.889389038086): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744103 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744103 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (480.89027404785): 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 (43.153762817383): 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 (39.815902709961): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

158 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744103 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744103 AND published='1' LIMIT 1

159 (38.14697265625): select jos_twitters.link from jos_twitters where cat=10

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

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (66.041946411133): select jos_linkedin.link from jos_linkedin where cat=10

163 (276.08871459961): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1526.1173248291): insert into jos_banners_delta values (14615,'2025-06-25 21:32:22','216.73.216.120','view'),(14202,'2025-06-25 21:32:22','216.73.216.120','view'),(14203,'2025-06-25 21:32:22','216.73.216.120','view')

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