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Perfusion Imaging May Be Better Sign of Blood Vessel Narrowing and Early Coronary Artery Disease

By MedImaging International staff writers
Posted on 03 Mar 2010

Cardiologists and heart imaging specialists at 15 medical centers in eight countries have enrolled the first dozen patients in a one-year investigation to learn whether the slight squeezing of blood flow through the inner layers of the heart is better than traditional single photon emission computed tomography (SPECT) nuclear imaging tests and other diagnostic radiology procedures for accurately tracking the earliest signs of coronary artery clogs.

Each year, nearly 800,000 American men, and women with coronary artery disease suffer a heart attack, resulting in more than 150,000 deaths. The latest international study of computed tomography (CT) perfusion imaging, led by researchers from Johns Hopkins University (Baltimore, MD, USA), will involve the participation of some 400 men and women identified as being at higher risk of coronary artery disease because they have had symptoms of the illness, such as shortness of breath, chest pain, or fatigue. All qualify for a more detailed inspection of their heart's blood vessels by cardiac catheterization, an invasive procedure in which a thin plastic tube is directly inserted into the heart's blood vessels to detect blockages and help widen each artery as needed.

"Our study goal is to out how well various imaging tests measure the degree of blockage or narrowing in any particular artery, and therefore, which is more useful in predicting patients who need catheterization or angioplasty, or bypass surgery,” said cardiologist and senior study investigator João Lima, M.D. "Some patients would do just as well or better with drug therapy to maintain a healthy blood flow to the heart, but we need to better sort out who they are with more accuracy.”

According to Dr. Lima, that as many as one-fifth of the 1.3 million cardiac catheterizations performed each year in the United states show no blockages. In addition to having a standard SPECT imaging test in which radioactive chemicals are injected into the body to produce three dimensional (3D) images of the blood vessels, all study participants will undergo before catheterization another test to map out the blood vessels and any potential blockages, a computed tomography (CT) angiogram (CTA), plus a CT perfusion (CTP) imaging test to gauge any changes in the volume of blood flow.

Key to performing both CTA and CTP is use of the 320 CT scanner, the most sophisticated technology available to image the heart and its surrounding blood vessels. The device was first installed in North America at Johns Hopkins in 2007 and can produce 3D images of blood vessels no bigger than the average width of a toothpick (1.5 mm). Results from both 320-CT tests will be compared to those from SPECT and what is found by cardiac catheterization.

"Perfusion imaging is a simple and easy test for patients to undergo,” noted Dr. Lima, who adds that the whole procedure usually takes less than 20 minutes to set up and perform. Cardiac catheterization, which also checks for heart vessel blockages, takes longer, between 30 minutes and 45 minutes to perform, and requires several hours for recovery. Potential complications from the invasive procedure, although rare, include heart attack, stroke, and death.

"If we can more easily examine patients, then we can reduce the amount of time needed in hospital, and we hope, reduce the number of invasive procedures, which are more inconvenient and open to greater risk to patients from complications,” said Dr. Lima, a professor of medicine and radiology at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute.

Lead study investigator and cardiologist Richard George, M.D., part of the Johns Hopkins team that developed special computer software to accurately measure the speed of blood flowing through the heart's arteries and muscle, reported that the 320-CT is fast and exposes patients to far less radiation. Dr. George, an assistant professor at Hopkins where he also serves as director of its CT Perfusion Laboratory, reported that a CTP takes three seconds or less of actual scanning and, if done correctly, involves an average radiation exposure of about 8 millisieverts. A SPECT test, he stated, averages between 10 millisieverts and 26 millisieverts, and cardiac catheterization ranges between 2 millisieverts and 10 millisieverts. The 320-CT scanning device has at least five times the speed and power of the 64-CT scanners in widespread use elsewhere.

The scanner's software compares ratios of brightly dyed blood flows between the innermost and outermost layers of heart muscle, where the effects of arterial narrowing first appear. As part of CTP imaging, each patient is injected with a chemical dye containing iodine, known to light up on screen when struck by the scanner's X-rays. Lower concentrations of iodine will show up as darker regions, indicating constrained and reduced blood flow, the underlying cause of chest pain, than brighter regions where blood flow is more uniform and free flowing. To enhance the image, blood flow to the heart is sped up through chemical injections of adenosine, which causes the blood-pumping organ to beat faster.

Earlier research by the team among 60 patients with suspected coronary artery disease showed that using dual testing with CTA and CTP had almost the same statistical predictive values as SPECT, prompting the team's latest investigation to see if the dual tests were as clinically useful as SPECT.

Dr. George cautioned that CT scans are not a substitute for catheterization, but are "an alternative diagnostic tool” physicians can use to "get a real picture” of the extent of coronary blockages and their effects on blood flow, particularly when physicians need both sets of information to make treatment decisions.

The CT device being used in the study is an Aquilion One, a 320 detector-row CT scanner manufactured by Toshiba Medical Systems (Tokyo, Japan). Toshiba also provided funding support for the study, called CORE-320 (Coronary Artery Evaluation Using 320-row multidetector CT scanner).

The CORE-320 study follows another imaging study, called CORE-64, which demonstrated that 64-CT was almost as good as cardiac catheterizations in predicting which patients with suspected coronary disease actually had coronary blockages.

Related Links:
Johns Hopkins University
Toshiba Medical Systems

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56 (187.15858459473): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

57 (108.00361633301): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (600.81481933594): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1805.0670623779): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

60 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

61 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

62 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

63 (!!!!! 2284.049987793): 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

64 (526.90505981445): SELECT fid FROM jos_deeppockets WHERE id=294728273 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728273 AND published='1' LIMIT 1

65 (86.069107055664): 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`

66 (!!!!! 2294.7788238525): select jos_twitters.link from jos_twitters where cat=10

67 (66.041946411133): select jos_facebook.link from jos_facebook where cat=10

68 (37.193298339844): select jos_google_plus.link from jos_google_plus where cat=10

69 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

70 (59.127807617188): SELECT fid FROM jos_deeppockets WHERE id=294728273 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728273 AND published='1' LIMIT 1

71 (72.002410888672): 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`

72 (291.10908508301): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (211.00044250488): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (54.836273193359): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 2343.8930511475): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (94.890594482422): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (113.01040649414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (33.855438232422): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (37.908554077148): 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`

92 (144.00482177734): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (79.154968261719): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (87.976455688477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (64.13459777832): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (509.97734069824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

107 (!!!!! 2742.0520782471): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

108 (112.05673217773): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (89.168548583984): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (144.95849609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

111 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

112 (134.94491577148): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (747.9190826416): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (866.88995361328): 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

115 (612.97416687012): 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

116 (242.94853210449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

117 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

118 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

119 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

120 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

121 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

122 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

123 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

124 (304.9373626709): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 52989.00604248): 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

126 (823.02093505859): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728273 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728273 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 23140.907287598): ( 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

128 (102.04315185547): ( 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

129 (172.13821411133): 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

130 (113.96408081055): 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

131 (88.930130004883): 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

132 (48.87580871582): 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

133 (484.94338989258): 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

134 (66.041946411133): 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

135 (63.180923461914): 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

136 (44.107437133789): 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

137 (586.03286743164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (489.95018005371): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (77.962875366211): SELECT name FROM jos_deeppockets WHERE id=213

140 (44.107437133789): SELECT name FROM jos_deeppockets WHERE id=213

141 (832.08084106445): 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

142 (841.14074707031): 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

143 (121.8318939209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

144 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

145 (!!!!! 11981.964111328): TRUNCATE TABLE jos_trademed_module

146 (221.96769714355): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (118.97087097168): 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=294728273 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (634.90867614746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (174.04556274414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

151 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

152 (!!!!! 2026.0810852051): 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

153 (125.16975402832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

154 (121.11663818359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

155 (69.856643676758): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728273 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728273 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (66.041946411133): 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)

157 (47.922134399414): 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)

158 (96.08268737793): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (!!!!! 1864.9101257324): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

160 (!!!!! 1951.9329071045): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728273 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728273 AND published='1' LIMIT 1

161 (110.86463928223): select jos_twitters.link from jos_twitters where cat=10

162 (46.968460083008): select jos_facebook.link from jos_facebook where cat=10

163 (42.915344238281): select jos_google_plus.link from jos_google_plus where cat=10

164 (40.769577026367): select jos_linkedin.link from jos_linkedin where cat=10

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