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Molecular Imaging Provides Early Diagnosis, Treatment for Patients with Aortic Dissections

By MedImaging International staff writers
Posted on 02 Jun 2010

Image: Colored computed tomography (CT) scan of a patient with a dissection of the aorta (Photo courtesy of Du Cane Medical Imaging).

Recent research revealed that molecular imaging could help physicians detect aortic dissection--a frequently lethal blood vessel condition--and help guide treatment.

Aortic dissection occurs when a tear in the wall of the aorta causes blood to flow between the layers of the wall of the aorta and force the layers apart. The study's findings were published in the May 2010 issue of the Journal of Nuclear Medicine (JNM). "Many conventional forms of imaging are not able to clearly differentiate between acute and chronic dissection,” said Hans-Henning Eckstein, M.D., Ph.D., a professor at the Technical University of Munich (TUM; Germany) and corresponding author the study. "It is critical to patients' survival that doctors are able to verify acute or exclude chronic aortic dissection so they can decide the best course of treatment--whether that means rushing the patient to surgery in some cases or using beta blockers to lower the blood pressure.”

Aortic dissection is the 10th leading cause of death in Western societies. It is the second most frequent cause of acute chest pain. In clinically unclear cases, use of a sophisticated imaging technique--positron emission tomography (PET) with the imaging agent fluorodeoxyglucose (FDG) and computed tomography (CT)--may help determine the age of an aortic dissection, the level of risk, and the need for surgery. Articles by researchers in Japan, Germany, and the United Kingdom reported on the results of two studies that used FDG PET/CT to diagnose aortic dissection.

In the Munich study, researchers assessed patients who had symptoms of aortic dissection and patients with chronic asymptomatic dissection using FDG PET/CT to acquire images of the affected area, just above the heart. These images were studied to determine the difference between the two forms of aortic dissection. The investigators noted that acute dissection of the aortic wall led to elevated metabolic activity in fresh lacerated segments of the aortic wall, while stable chronic aortic dissection showed no increased metabolic activity. They speculated that increased metabolic activity in cases of acute aortic dissection is due to repair processes of the aortic wall injury, causing cell activation and accumulation, and that low metabolic activity in chronic aortic dissection is due to scar tissue. Additional studies, according to the researchers, are needed to validate these hypotheses.

In another study reported in the same issue of JNM, researchers in Japan found that greater metabolic activity in acute aortic dissection was considerably associated with increased risk for rupture and progression. The study demonstrated that FDG PET/CT might be used to improve patient management, although more studies are still needed to clarify its role in the clinical setting.

"Usually, it is difficult to predict poor outcome for patients receiving medical treatment for acute aortic dissection,” said Toyoaki Murohara, M.D., Ph.D., F.A.H.A., a professor at Nagoya University Graduate School of Medicine (Japan) and one of the authors of the study. "This study will give us new information to evaluate the degree of the patients' illness.”

"Early diagnosis and treatment are essential for survival of patients with this rare and often fatal disease,” concluded James H.F. Rudd, M.D., Ph.D., M.R.C.P., a researcher and consultant cardiologist at the University of Cambridge (UK), who authored an invited perspective article in JNM on the role of ¹⁸F-FDG PET in aortic dissection. "Although further studies are needed, this research suggests that FDG PET imaging might be used to identify patients who are at a very high risk of complications, allowing them to be fast-tracked to surgery.”

Related Links:
Technical University of Munich
Nagoya University Graduate School of Medicine
University of Cambridge

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59 (!!!!! 3367.9008483887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

60 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

61 (!!!!! 21404.981613159): 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 (!!!!! 7749.080657959): SELECT fid FROM jos_deeppockets WHERE id=294729584 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294729584 AND published='1' LIMIT 1

63 (!!!!! 7869.0052032471): 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 (!!!!! 7488.0123138428): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 8004.903793335): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 7814.884185791): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 7926.9409179688): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 7804.1553497314): SELECT fid FROM jos_deeppockets WHERE id=294729584 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294729584 AND published='1' LIMIT 1

69 (!!!!! 7913.1126403809): 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 (!!!!! 7713.794708252): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 7889.0323638916): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 7298.9463806152): 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 (833.03451538086): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 1514.9116516113): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (113.96408081055): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (422.00088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (60.796737670898): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (335.9317779541): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (365.9725189209): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 1631.9751739502): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (478.02925109863): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 3671.8845367432): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (56.982040405273): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.007995605469): 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 (684.97657775879): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (67.949295043945): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (283.00285339355): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (272.03559875488): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (315.90461730957): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (63.896179199219): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (334.02442932129): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1279.8309326172): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

105 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

106 (!!!!! 4004.955291748): 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=294729584 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 1343.0118560791): 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=294729584 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 1549.0055084229): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

109 (243.9022064209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

110 (242.94853210449): 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=294729584 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (713.10997009277): 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=294729584 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1070.0225830078): 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 (!!!!! 1391.1724090576): 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 (!!!!! 1020.1930999756): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

115 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

116 (!!!!! 1090.0497436523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

117 (!!!!! 1101.9706726074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

118 (!!!!! 1400.9475708008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

119 (!!!!! 1701.1165618896): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

120 (!!!!! 5445.0035095215): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

121 (363.11149597168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

122 (!!!!! 3767.0135498047): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 81020.11680603): 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 (957.01217651367): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729584 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729584 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 21326.065063477): ( 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 (72.956085205078): ( 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 (308.03680419922): 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 (50.067901611328): 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 (397.92060852051): 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 (49.114227294922): 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 (797.98698425293): 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 (51.975250244141): 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 (511.88468933105): 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 (363.11149597168): 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 (473.97613525391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (401.02005004883): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (112.05673217773): SELECT name FROM jos_deeppockets WHERE id=213

138 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=213

139 (703.09638977051): 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 (802.99377441406): 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 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

142 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

143 (!!!!! 9434.9384307861): TRUNCATE TABLE jos_trademed_module

144 (143.05114746094): 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=294729584 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (64.13459777832): 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=294729584 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (505.92422485352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (230.07392883301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

149 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

150 (!!!!! 1835.823059082): 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 (125.88500976562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

152 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

153 (93.936920166016): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294729584 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294729584 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (46.014785766602): 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 (83.92333984375): 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 (45.061111450195): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (221.01402282715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

158 (!!!!! 3400.0873565674): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294729584 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294729584 AND published='1' LIMIT 1

159 (59.843063354492): select jos_twitters.link from jos_twitters where cat=10

160 (55.074691772461): select jos_facebook.link from jos_facebook where cat=10

161 (44.822692871094): select jos_google_plus.link from jos_google_plus where cat=10

162 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

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