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Canadian Mother Is First North American to Receive MRI-Compatible Defibrillator Implant

By MedImaging International staff writers
Posted on 12 Feb 2013

Image: The new Lumax 740 series is part of Biotronik’s product portfolio of tachyarrhythmia therapy devices with the ProMRI technology (Photo courtesy of Biotronik).

New technology is providing lifesaving prospects for thousands of cardiac patients currently denied magnetic resonance imaging (MRI) scanning.

Every year, an estimated 1.5 million MRI scans are performed in Canada alone and the number is growing at a rate of approximately 10% per year. At the same time, a mounting number of Canadians who rely on implanted defibrillators to keep their hearts beating are denied this beneficial, life-saving diagnostic test in spite of a 50%–75% probability that they will require one over the lifetime of their defibrillator.

In December 2012, cardiac patient Justine Bovenkerk, a 35-year-old wife and mother from Newmarket (ON, Canada), needed a defibrillator implant to treat a heart disorder, but also required undergoing regular MRI scans to monitor other health conditions. The Heart Rhythm Program at Southlake Regional Health Center (Newmarket, ON, Canada) became the first medical team in North America to insert an MRI-friendly implantable cardioverter defibrillator (ICD) into this patient’s heart.

“We were in a bind,” said Dr. Atul Verma, an electrophysiologist at Newmarket’s Southlake Regional Health Center, noting that there are no MRI-safe defibrillators currently licensed for use in Canada. The drawback is that MRI scans can cause disturbances that affect implanted defibrillators, resulting in potential injury to patients. One alternative would have been to forego the MRI and use computed tomography (CT) scans, which would have been less successful as a monitoring application, and the other was to use an MRI-safe pacemaker that could not have provided the full protection against cardiac arrest that her heart needs. “We didn’t feel good about either option.”

After learning about an MRI-safe defibrillator widely used in Europe—the Lumax ProMRI supplied by Biotronik Canada, Inc. (Etobicoke, ON, Canada)—Southlake’s Heart Rhythm Program applied for and received Health Canada’s approval to use the device to treat Ms. Bovenkerk. The minimally invasive procedure was performed on December 24, 2012, allowing the young mother to be home with her family on Christmas Day. “It was a true team effort, from the triage coordinator who helped to schedule the procedure at the last minute, to the nurses who worked a little later than normal on one of the most popular holidays of the year,” noted Dr. Verma.

The MRI-friendly defibrillator is implanted in the same way as other ICDs, using a small incision near the collarbone. Wires are floated through the veins and attached to the heart while the “brains” of the technology, stored on a small computer chip, are inserted under the skin near the incision. If the patient’s heart starts to beat too rapidly or too slow, the device will readjust the beats to a normal rhythm. If a patient goes into cardiac arrest, it will shock the heart in the same manner as defibrillator panels used outside the body.

“Heart disease is the number one killer of Canadians and defibrillators are increasingly used for anyone who is at risk of cardiac arrest, including people who have had prior heart attacks, people who have advanced degrees of heart failure or people with special inherited conditions as in the case of Justine,” Dr. Verma explained. “Meanwhile, MRI is becoming the diagnostic test of choice. Normally, a radiologist will say no to a patient with an ICD, and now we have a solution.”

Currently, the only MRI-safe device available in Canada is a pacemaker that is different from a defibrillator because it can only speed up the heart when it beats too slowly. It does not have the capability to slow down the heart when it beats too rapidly and cannot shock the heart in the event of cardiac arrest. Last year, 8,300 defibrillator implants were performed in Canada, a number that is growing at a rate of 10%–15% annually.

What sets the Biotronik device apart from other defibrillator implants is a special programming feature that provides an MRI mode, allowing patients to safely undergo an MRI scan with simply the wave of a wand. “There’s a wireless wand we wave over the patient to download information from any implanted defibrillator to a laptop,” explained Dr. Verma. “If you need to program the device differently—or in this case, set the MRI mode—you just type in what you need, wave the wand again, and it automatically updates the device inside the patient.”

Expected to receive Health Canada approval in the spring of 2012, the MRI-friendly defibrillator represents a giant step forward, Dr. Varna added. The MRI-safe mode, for example, alerts the device that it is about to detect an abnormal amount of background noise or disturbance due to the magnetic fields used in an MRI so that it can adjust appropriately. This removes the risk of the MRI interfering with normal performance of the device and possibly causing harm to a patient. MRI-friendly defibrillators also have slight differences in structure and composition that make them safer to operate in magnetic fields.

“At Southlake, our culture is one of innovation,” stated Dr. Dave Williams, Southlake president and CEO. “We relentlessly challenge ourselves to find new ways to achieve more successful outcomes for our patients. The fact that Justine Bovenkerk can now receive the diagnostic testing she needs speaks volumes. As an organization, we could not be more thrilled.”

Related Links:
Southlake Regional Health Center
Biotronik Canada

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55 (337.83912658691): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (422.95455932617): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 2677.9174804688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

58 (193.11904907227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

59 (!!!!! 2928.0185699463): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

60 (!!!!! 3870.964050293): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

61 (!!!!! 5375.1468658447): 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 (!!!!! 4004.0016174316): SELECT fid FROM jos_deeppockets WHERE id=294744736 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744736 AND published='1' LIMIT 1

63 (89.168548583984): 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 (180.95970153809): select jos_twitters.link from jos_twitters where cat=10

65 (127.07710266113): select jos_facebook.link from jos_facebook where cat=10

66 (102.99682617188): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 3091.0968780518): select jos_linkedin.link from jos_linkedin where cat=10

68 (103.95050048828): SELECT fid FROM jos_deeppockets WHERE id=294744736 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744736 AND published='1' LIMIT 1

69 (!!!!! 2166.9864654541): 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 (975.13198852539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (972.03254699707): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744736 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 (411.03363037109): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (312.08992004395): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (102.99682617188): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (151.15737915039): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (174.99923706055): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (452.99530029297): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (102.04315185547): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (424.14665222168): 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 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (!!!!! 3465.8908843994): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (117.06352233887): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 1682.0430755615): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (96.08268737793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2997.875213623): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

105 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

106 (!!!!! 3179.0733337402): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (939.84603881836): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (163.07830810547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

109 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

110 (!!!!! 3465.8908843994): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 3877.8781890869): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (767.94624328613): 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 (556.94580078125): 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 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

115 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

116 (99.18212890625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

117 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

118 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

119 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

120 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

121 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

122 (428.91502380371): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 58712.005615234): 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 (775.09880065918): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744736 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744736 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 23438.930511475): ( 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 (65.088272094727): ( 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 (41.007995605469): 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 (32.901763916016): 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 (65.088272094727): 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 (46.968460083008): 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 (495.19538879395): 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 (72.002410888672): 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 (78.916549682617): 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 (46.968460083008): 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 (566.95938110352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (442.9817199707): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (45.061111450195): SELECT name FROM jos_deeppockets WHERE id=212

138 (42.915344238281): SELECT name FROM jos_deeppockets WHERE id=212

139 (664.23416137695): 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 (595.8080291748): 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 (623.94142150879): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

142 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

143 (!!!!! 14536.142349243): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1699.9244689941): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 2704.1435241699): 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=294744736 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3353.1188964844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (131.13021850586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

149 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

150 (!!!!! 1202.1064758301): 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 (287.05596923828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

152 (503.0632019043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

153 (155.92575073242): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744736 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744736 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (135.18333435059): 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 (32.901763916016): 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 (275.85029602051): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2050.1613616943): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

158 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744736 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744736 AND published='1' LIMIT 1

159 (555.03845214844): select jos_twitters.link from jos_twitters where cat=10

160 (46.968460083008): select jos_facebook.link from jos_facebook where cat=10

161 (102.04315185547): select jos_google_plus.link from jos_google_plus where cat=10

162 (308.99047851562): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 6133.0795288086): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 4011.1541748047): insert into jos_banners_delta values (14615,'2025-06-25 20:28:29','216.73.216.120','view'),(14202,'2025-06-25 20:28:29','216.73.216.120','view'),(14203,'2025-06-25 20:28:29','216.73.216.120','view')

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