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Decision Support Software To Assist in the Differential Diagnosis of Dementia

By MedImaging International staff writers
Posted on 12 Nov 2008

A usability and feasibility study of a decision-support software tool for the automatic evaluation of dementia using positron emission tomography (PET) image data has just been successfully concluded.

The Philips Research (Best, The Netherlands) software has been evaluated in collaboration with the University Medical Center Hamburg-Eppendorf (Hamburg, Germany) and Austin Hospital (Melbourne, Australia).

Currently, one of the most effective ways of diagnosing dementia in its earlier stages is by performing a PET brain scan with the tracer fluorodeoxyglucose (FDG). FDG-PET is a molecular imaging technique that produces a three-dimensional image of functional processes in the body--in this case, the uptake of glucose that fuels brain activity. However, the interpretation of PET brain-scan images requires a great amount of skill, especially in the early stages of neurodegenerative disease.

The Philips decision support software has shown positive results in retrospective studies using libraries of FDG-PET brain-scan images that had already been independently interpreted by an expert. In a study based on a University Medical Center Hamburg-Eppendorf library of FDG-PET scans from 83 patients, the software achieved better than 98% correspondence with the expert physician's interpretation when programmed to differentiate between brain scans showing no signs of dementia, brain scans characteristic of Alzheimer's disease and those characteristic of frontotemporal dementia.

In a similar 48-patient study using FDG-PET images provided by Prof. Christopher Rowe, director of Nuclear Medicine & Center for PET at the Austin Hospital, the software achieved better than 80% accuracy in differentiating between the scans of nondiseased patients, those suffering from Alzheimer's, frontotemporal dementia, and Lewy body dementia. This so-called four-class differential diagnosis is more difficult because indications of Alzheimer's and Lewy body dementia occur in similar areas of the brain, while indications of frontotemporal dementia appear in a separate area of the brain.

Dementia currently affects well over 25 million people worldwide. It is the result of a number of progressive degenerative diseases of the brain. The most common dementia causing diseases are Alzheimer's disease, Lewy-body dementia, and frontotemporal dementia--accounting for around 60%, 15%, and 10% of all dementia cases, respectively. Early differential diagnosis of the type of dementia that a patient is suffering from is essential to maximize the benefit of available drugs that can prevent rapid deterioration and subsequent loss in quality of life.

The Philips software analyses PET brain-scan images, and combines them with magnetic resonance imaging (MRI) scans to detect the characteristic patterns of brain diseases such as Alzheimer's, frontotemporal dementia, and Lewy Body dementia, and then quantifies the degree to which they resemble reference images of known dementia sufferers. The University Medical Center Hamburg-Eppendorf, codeveloper of the system, has been using the software alongside its existing diagnostic procedures for the last year to evaluate its feasibility and usability in a clinical setting.

"The results of the study have been truly excellent,” commented Dr. Ralph Buchert of the department of nuclear medicine at the University Medical Center Hamburg-Eppendorf. "With most steps performed automatically, operating the software is very straightforward and only adds a couple of minutes to the procedure time. When we made it available to referring physicians who were not skilled in reading FDG-PET and MRI images, they were able to analyze images and interpret the results within a few minutes.”

"Computer-based clinical decision support is regarded as one of the best ways of enabling physicians to optimally use available data and knowledge so that they can consistently deliver evidence-based medicine to their patients in a timely manner,” stated Dr. Henk van Houten, senior vice president Philips Research and head of the Healthcare research program. "Ultimately, such systems will be judged by the people who use them, and that is why it is important to develop this decision support software to aid the diagnosis of dementia in close collaboration with leading dementia research institutes.”

Following up on from the encouraging results of these studies, Philips Research is conducting additional studies involving the software in collaboration with the University of Washington (Seattle, USA).

Related Links:
Philips Research
University Medical Center Hamburg-Eppendorf

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58 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

59 (238.89541625977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

60 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

61 (776.05247497559): 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 (!!!!! 2031.0878753662): SELECT fid FROM jos_deeppockets WHERE id=294721036 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294721036 AND published='1' LIMIT 1

63 (504.97055053711): 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=213 ORDER BY `ordering`

64 (612.02049255371): select jos_twitters.link from jos_twitters where cat=10

65 (318.05038452148): select jos_facebook.link from jos_facebook where cat=10

66 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

67 (34.093856811523): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 2188.9209747314): SELECT fid FROM jos_deeppockets WHERE id=294721036 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294721036 AND published='1' LIMIT 1

69 (62.942504882812): 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=213 ORDER BY `ordering`

70 (342.13066101074): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (550.0316619873): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.982040405273): 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 (78.916549682617): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.087066650391): 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 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (53.882598876953): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (44.107437133789): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (!!!!! 1718.9979553223): 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 (!!!!! 1576.9004821777): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (182.8670501709): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (456.09474182129): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (569.82040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (498.05641174316): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (180.95970153809): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (406.02684020996): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (168.0850982666): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (465.86990356445): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (360.96572875977): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4811.0485076904): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

105 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

106 (505.92422485352): 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=294721036 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (622.03407287598): 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=294721036 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1817.9416656494): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

109 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

110 (69.856643676758): 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=294721036 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (784.87396240234): 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=294721036 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 3647.0890045166): 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 (!!!!! 3684.9975585938): 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 (564.8136138916): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

115 (538.11073303223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

116 (587.94021606445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

117 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

118 (632.04765319824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

119 (562.90626525879): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

120 (89.168548583984): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

121 (962.0189666748): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

122 (339.98489379883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 55768.013000488): 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 (!!!!! 3453.0162811279): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721036 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721036 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 16348.123550415): ( 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 (77.009201049805): ( 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 (410.07995605469): 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 (51.021575927734): 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 (324.96452331543): 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 (205.99365234375): 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 (576.01928710938): 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 (47.922134399414): 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 (571.01249694824): 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 (47.206878662109): 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 (!!!!! 2763.9865875244): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (427.9613494873): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 3421.0681915283): SELECT name FROM jos_deeppockets WHERE id=213

138 (99.18212890625): SELECT name FROM jos_deeppockets WHERE id=213

139 (766.03889465332): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 2611.1602783203): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

142 (259.1609954834): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

143 (!!!!! 27549.028396606): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 7607.9368591309): 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=294721036 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1204.9674987793): 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=294721036 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1170.8736419678): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2125.9784698486): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

149 (!!!!! 5496.0250854492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

150 (!!!!! 1712.7990722656): 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 (149.96528625488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

152 (!!!!! 1377.1057128906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

153 (699.04327392578): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294721036 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294721036 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (616.07360839844): 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=213 or channel_id is null)

155 (51.975250244141): 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=213 or channel_id is null)

156 (40.054321289062): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

158 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294721036 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294721036 AND published='1' LIMIT 1

159 (62.942504882812): select jos_twitters.link from jos_twitters where cat=10

160 (32.186508178711): select jos_facebook.link from jos_facebook where cat=10

161 (32.186508178711): select jos_google_plus.link from jos_google_plus where cat=10

162 (34.809112548828): select jos_linkedin.link from jos_linkedin where cat=10

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