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MRI Mapping Improves Deep Brain Stimulation Response in Resistant Depression

By MedImaging International staff writers
Posted on 15 May 2014

Image: A study using MRI analysis of the white matter connections examined the architecture of this network in patients who demonstrated significant response to subcallosal cingulate deep-brain stimulation (Photo courtesy of Woodruff Health Sciences Center, Emory University).

Research studies have shown that deep brain stimulation (DBS) within the brain’s subcallosal cingulate (SCC) white matter is an effective therapy for many patients with treatment-resistant depression. Response rates to date have been between 41% and 64% across published studies. One of the proposed mechanisms of action is through modulation of a network of brain regions connected to the SCC. Identifying the critical connections within this network for successful antidepressant response is a significant next step.

A new study using magnetic resonance imaging (MRI) analysis of the white matter connections examined the network’s architecture in patients who demonstrated significant response to SCC DBS. Researchers discovered that all responders showed a common pattern defined by three distinct white matter bundles passing through the SCC. Non-responders did not show this pattern.

The study was published online April 11, 2014, in the journal Biological Psychiatry. “This study shows that successful DBS therapy is not due solely to local changes at the site of stimulation but also in those regions in direct communication with the SCC,” stated senior author of the article, Helen Mayberg, MD, a professor of psychiatry, neurology and radiology, and chair of psychiatric imaging and therapeutics at Emory University School of Medicine (Atlanta, GA, USA). “Precisely delineating these white matter connections appears to be very important to a successful outcome with this procedure. From a practical point of view, these results may help us to choose the optimal contact for stimulation and eventually to better plan the surgical placement of the DBS electrodes.”

Led by researchers from Emory University Case Western Reserve University (Cleveland, OH, USA), and Dartmouth University (Hanover, NH, USA), the study included 16 patients with treatment-resistant depression who previously received SCC DBS at Emory. Computed tomography (CT) scanning was used postoperatively to localize the DBS contacts on each electrode. The activation volumes around the active contacts were modeled for each patient. Sophisticated neuroimaging combined with computerized analysis was used to derive and visualize the specific white matter fibers affected by ongoing DBS.

Therapeutic outcome was evaluated at six months and at two years. Six of the patients had responded positively to DBS at six months, and by two years these six in addition to six more patients responded positively. All shared common involvement of three distinct white matter bundles: the forceps minor, cingulum, and the uncinate fasciculus. The conversion of six of the patients who were not responding at six months to being responders at two years was clarified by the inclusion of all three bundles due to alterations in stimulation settings. Nonresponders at both six months and two years revealed incomplete involvement of these three tracts.

“In the past, placement of the electrode relied solely on anatomical landmarks with contact selection and stimulation parameter changes based on a trial-and-error method,” stated Patricio Riva-Posse, MD, assistant professor of psychiatry and behavioral sciences at Emory and first author of the article. “These results suggest that clinical outcome can be significantly influenced by optimally modulating the response network defined by tractography. This obviously will need to be tested prospectively in additional subjects here and by other teams exploring the use of this experimental treatment.”

“This new information will allow us to develop a refined algorithm for guiding surgical implantation of electrodes and optimizing the response through fine tuning of stimulation parameters,” noted Dr. Mayberg. “That said, improving anatomical precision alone doesn’t account for all nonresponders, so that is an important next focus of our research.”

The researchers now plan to study DBS therapy in a prospective group of similar treatment-resistant depressed patients, using presurgical mapping of an individual patient’s network structure, precisely targeting the three SCC fiber bundles, and systematically testing the stimulation contacts.

Related Links:
Emory University School of Medicine
Case Western Reserve University
Dartmouth University

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58 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

59 (126.83868408203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

60 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

61 (92.983245849609): 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 (528.81240844727): SELECT fid FROM jos_deeppockets WHERE id=294752443 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752443 AND published='1' LIMIT 1

63 (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`

64 (58.174133300781): select jos_twitters.link from jos_twitters where cat=10

65 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

66 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

67 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

68 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE id=294752443 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752443 AND published='1' LIMIT 1

69 (32.186508178711): 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 (202.89421081543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (138.99803161621): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (35.04753112793): 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 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (33.855438232422): 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 (121.11663818359): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): 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 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (125.16975402832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

105 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

106 (66.995620727539): 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=294752443 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=294752443 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (81.777572631836): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

109 (874.99618530273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

110 (426.05400085449): 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=294752443 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (423.19297790527): 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=294752443 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (569.10514831543): 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 (312.08992004395): 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 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

115 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

116 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

117 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

118 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

119 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

120 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

121 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

122 (221.96769714355): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 21699.905395508): 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 (540.01808166504): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752443 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752443 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8163.9289855957): ( 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 (77.962875366211): ( 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 (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

128 (30.994415283203): 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 (41.961669921875): 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 (29.087066650391): 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 (199.0795135498): 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 (38.14697265625): 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 (32.901763916016): 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 (41.007995605469): 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 (352.14424133301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (222.92137145996): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 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 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=212

139 (685.9302520752): 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 (617.98095703125): 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 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

142 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

143 (!!!!! 9194.8509216309): TRUNCATE TABLE jos_trademed_module

144 (103.95050048828): 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=294752443 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (68.902969360352): 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=294752443 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1047.1343994141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

149 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

150 (!!!!! 1302.0038604736): 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 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

152 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

153 (42.915344238281): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752443 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752443 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (38.14697265625): 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 (36.001205444336): 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 (43.869018554688): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (176.90658569336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

158 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752443 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752443 AND published='1' LIMIT 1

159 (51.021575927734): select jos_twitters.link from jos_twitters where cat=10

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

161 (36.001205444336): select jos_google_plus.link from jos_google_plus where cat=10

162 (35.04753112793): select jos_linkedin.link from jos_linkedin where cat=10

163 (330.92498779297): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1226.9020080566): insert into jos_banners_delta values (14615,'2025-06-24 04:16:34','216.73.216.120','view'),(14202,'2025-06-24 04:16:34','216.73.216.120','view'),(14203,'2025-06-24 04:16:34','216.73.216.120','view')

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