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Dual-Isotope SPECT/CT Imaging Reduces Amputations in Diabetic Patients

By MedImaging International staff writers
Posted on 28 Jun 2011

New research has revealed the extent to which an ongoing study can help save life and limb for patients with diabetes-related foot infections.

Diabetes can cause nerve damage and reduced blood flow to the bones and tissues of the feet, leaving diabetics susceptible to infection. This study demonstrated that combining two imaging agents with molecular imaging techniques provides diabetic patients an excellent infection screening method that has already spared a number of patients from aggressive amputation of infected feet.

"As a result of this study we have concluded that dual isotope SPECT/CT [single photon emission tomography/computed tomography] is an important method for detecting infection in diabetic patients who might otherwise receive unnecessarily aggressive treatment such as amputation," noted Sherif Heiba, MD, associate professor of radiology at Mount Sinai School of Medicine (New York, NY, USA). "We want to avoid amputation whenever possible, because it has been shown to be detrimental to patients in terms of both quality of life and survival."

According to the American Diabetes Association, an estimated 25.8 million people, including children, have diabetes, and approximately 79 million people across the country could be prediabetic or at serious risk of developing diabetes, which is associated with a range of other debilitating diseases. Of all the complications of this disease, infections of the bone and tissues of the feet result in the highest number of hospitalizations among diabetic patients due to their hampered ability to heal from even minor ailments.

A total of 191 patients have participated in this study and undergone molecular imaging with two imaging agents known for their superior effectiveness with infected tissue and bone. Patients were scanned with SPECT/CT, which generates images with both functional and anatomic information about the body.

The study comprised 227 scans performed with dual isotopes technetium (Tc)-99m HDP and indium (In)-111 WBC. Scans were performed using Tc-99m SC and In-111 white blood cell (WBC) for patients suspected of having mid- or hind-foot infection.

Results showed 84 cases of osteomyelitis, 93 infections of the soft tissue, 25 combinations of both and 25 other pathologies. These diagnoses were accurately confirmed by tissue culture in 66 of the cases and follow-up examinations for 161 scans. There were only one false negative and five false-positive diagnoses for the entire cohort. Patient treatment planning was directed by 94% of imaging studies (207 scans). Of the 207 clinical decisions based on each scan, 72% (150) were followed with conservative therapy including local debridement of affected tissues and antibiotics, and 24% (49) of scans led to minor procedures such as partial bony resection and toe amputation in order to salvage the limb.

This research continues to provide additional proof that dual isotope SPECT/CT is highly effective for the assessment of diabetes-related soft-tissue infection and osteomyelitis, as well as for conservative treatment planning and limb salvage whenever possible.

The study's findings were presented at SNMs 58th annual meeting, held June 4-8, 2011, in San Antonio (TX, USA).

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63 (!!!!! 4162.073135376): 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 (!!!!! 1756.9065093994): SELECT fid FROM jos_deeppockets WHERE id=294735785 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735785 AND published='1' LIMIT 1

65 (453.23371887207): 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 (!!!!! 3669.9771881104): select jos_twitters.link from jos_twitters where cat=10

67 (45.7763671875): select jos_facebook.link from jos_facebook where cat=10

68 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

69 (245.09429931641): select jos_linkedin.link from jos_linkedin where cat=10

70 (809.90791320801): SELECT fid FROM jos_deeppockets WHERE id=294735785 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735785 AND published='1' LIMIT 1

71 (57.93571472168): 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 (!!!!! 1770.01953125): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (960.11161804199): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (51.975250244141): 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 (!!!!! 7484.1976165771): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 4920.9594726562): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 6922.0066070557): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 7143.0206298828): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 5723.237991333): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1354.9327850342): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (752.92587280273): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (449.89585876465): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (355.95893859863): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 1724.9584197998): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (782.01293945312): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (432.01446533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (360.96572875977): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (560.99891662598): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (252.96211242676): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (51.021575927734): 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 (!!!!! 1035.9287261963): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (288.00964355469): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (!!!!! 1380.9204101562): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (279.90341186523): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (440.12069702148): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (524.04403686523): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (233.17337036133): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (78.916549682617): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (260.82992553711): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (116.10984802246): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (844.95544433594): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (434.16023254395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

107 (491.85752868652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

108 (535.96496582031): 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=294735785 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 1760.9596252441): 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=294735785 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 2431.8695068359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

111 (395.05958557129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

112 (880.00297546387): 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=294735785 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (552.17742919922): 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=294735785 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 1335.1440429688): 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 (!!!!! 1621.0079193115): 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 (!!!!! 1101.016998291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

117 (578.88031005859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

118 (!!!!! 1816.0343170166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

119 (293.01643371582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

120 (823.02093505859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

121 (946.99859619141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

122 (!!!!! 4981.9946289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

123 (344.03800964355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

124 (509.02366638184): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 80255.98526001): 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 (!!!!! 2636.9094848633): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735785 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735785 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 2007.007598877): ( 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 (!!!!! 5892.0383453369): ( 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 (!!!!! 6188.8694763184): 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 (!!!!! 2300.9777069092): 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 (!!!!! 2243.9956665039): 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 (!!!!! 2442.8367614746): 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 (559.09156799316): 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 (399.11270141602): 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 (!!!!! 1405.0006866455): 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 (!!!!! 3494.9779510498): 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 (735.99815368652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (349.04479980469): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (44.107437133789): SELECT name FROM jos_deeppockets WHERE id=213

140 (27.894973754883): SELECT name FROM jos_deeppockets WHERE id=213

141 (628.94821166992): 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 (!!!!! 4571.1994171143): 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 (138.99803161621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

144 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

145 (!!!!! 31402.826309204): TRUNCATE TABLE jos_trademed_module

146 (662.08839416504): 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=294735785 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 3610.8493804932): 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=294735785 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (420.09353637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

151 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

152 (!!!!! 1473.9036560059): 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 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

154 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

155 (39.100646972656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735785 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735785 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (30.994415283203): 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 (26.941299438477): 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 (30.040740966797): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (125.88500976562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

160 (96.08268737793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735785 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735785 AND published='1' LIMIT 1

161 (37.908554077148): select jos_twitters.link from jos_twitters where cat=10

162 (26.941299438477): select jos_facebook.link from jos_facebook where cat=10

163 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

164 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

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