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First Guidelines Released for Brain Amyloid Imaging in Alzheimer’s Disease Patients

By MedImaging International staff writers
Posted on 04 Feb 2013

Only recently has it become possible to create high-quality images of the brain plaques characteristic of Alzheimer’s disease (AD) in living individuals by way of positron emission tomography (PET) imaging. Even so, there are still questions of what can be determined from these PET images and which people should have this imaging modality.

To provide guidance for physicians, individuals and families affected by Alzheimer’s, and the public, the Society of Nuclear Medicine and Molecular Imaging (SNMMI; Reston, VA, USA) and the Alzheimer’s Association (Chicago, IL, USA) have jointly published the first criteria for the appropriate use of this imaging technology to aid in the diagnosis of people with suspected AD. The criteria were published online January 28, 2013, as an article in press by Alzheimer’s & Dementia, the Journal of the Alzheimer’s Association and ahead of print in the Journal of Nuclear Medicine.

Whereas increased beta amyloid plaques are one of the definitive pathologic characteristics of AD, many elderly people with normal cognition also have elevated levels of these plaques, as do people with disorders other than AD dementia. Therefore, the potential clinical use of amyloid PET requires careful consideration so that its appropriate role may be identified.

To develop the new criteria, the Alzheimer’s Association and SNMMI assembled an Amyloid Imaging Taskforce (AIT) consisting of dementia and imaging specialists to review the scientific literature and develop consensus recommendations for the clinical use of this exciting new technology.

The AIT concluded that amyloid imaging could possibly be helpful in the diagnosis of people with cognitive impairment when considered along with other clinical information, and when performed according to standardized protocols by trained staff. In addition, they emphasized that the decision whether or not to order amyloid imaging should be made only after a comprehensive evaluation by a physician experienced in the assessment and diagnosis of cognitive impairment and dementia, and only if the presence or absence of amyloid would increase certainty in the diagnosis and alter the treatment plan.

According to the AIT, appropriate candidates for amyloid PET imaging include: (1) those individuals who complain of persistent or progressive unexplained memory problems or confusion and who demonstrate impairments using standard tests of cognition and memory. (2) Individuals meeting tests for possible Alzheimer’s, but who are unusual in their clinical presentation. (3) Individuals with progressive dementia and atypically early age of onset (before age 65).

Inappropriate candidates for amyloid PET imaging include: (1) those who are age 65 or older and meet standard definitions and tests for Alzheimer’s, because a positive PET scan would provide little added value. (2) Asymptomatic people or those with a cognitive complaint but no clinical confirmation of impairment.

Amyloid PET imaging is also inappropriate: (1) As a means of determining the severity of dementia. (2) When requested only based on a family history of dementia or presence of other risk factors for AD, such as the ApoE-e4 gene. (3) As a substitute for genetic testing for mutations that cause ADs. (4) For nonmedical reasons, such as insurance, legal or employment decisions.

The taskforce recognized that the healthcare provider has the final say regarding the care of each patient. The AIT sought to assist this process and identified the following general sequence of events for the use of amyloid PET according to the new criteria: (1) Assessment by dementia specialists to evaluate the need for diagnostic testing, perhaps to include amyloid PET if the AUC are met. (2) Referral to a qualified provider of amyloid PET services. (3) Performance, interpretation and reporting of the amyloid PET scan according to established standards. (4) Integration of the PET finding into the clinical assessment process. (5) Lastly, disclosure of PET findings by the clinician to the patient and caregivers, along with discussion of the result and its management consequences.

Although identifying potential benefits, the AIT concluded that amyloid PET findings will not constitute and is not equivalent to a clinical diagnosis of AD dementia. They reported that imaging is only one approach among many that clinicians should use judiciously to manage patients, and that amyloid PET imaging does not substitute for a careful history and examination.

If an amyloid imaging PET scan shows that a person with memory impairment has amyloid buildup in their brain, this increases the likelihood that the memory impairment is caused by AD, but it remains a probability, not inevitable. If an individual without memory problems or impairment has amyloid accumulation, it does not necessarily mean that they will develop AD.

Related Links:
Society of Nuclear Medicine and Molecular Imaging
Alzheimer’s Association

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60 (220.06034851074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

61 (!!!!! 3037.2142791748): 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 (474.92980957031): SELECT fid FROM jos_deeppockets WHERE id=294744609 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744609 AND published='1' LIMIT 1

63 (46.014785766602): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

64 (!!!!! 5290.9851074219): select jos_twitters.link from jos_twitters where cat=10

65 (102.04315185547): select jos_facebook.link from jos_facebook where cat=10

66 (39.815902709961): select jos_google_plus.link from jos_google_plus where cat=10

67 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

68 (560.99891662598): SELECT fid FROM jos_deeppockets WHERE id=294744609 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294744609 AND published='1' LIMIT 1

69 (111.10305786133): 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 (!!!!! 2503.8719177246): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (380.9928894043): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (49.829483032227): 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 (468.96934509277): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (924.11041259766): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (771.04568481445): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (45.7763671875): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (252.96211242676): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (287.05596923828): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1379.0130615234): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (139.95170593262): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (189.06593322754): 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 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

105 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

106 (76.055526733398): 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=294744609 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (54.836273193359): 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=294744609 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (83.208084106445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

109 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

110 (!!!!! 2676.0101318359): 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=294744609 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (766.03889465332): 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=294744609 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 6705.9993743896): 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 (!!!!! 4631.9961547852): 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 (!!!!! 2475.0232696533): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

115 (280.14183044434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

116 (874.04251098633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

117 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

118 (967.02575683594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

119 (100.13580322266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

120 (391.96014404297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 67800.998687744): 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

122 (385.04600524902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

123 (205.99365234375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

124 (916.95785522461): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744609 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744609 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 892513.99040222): ( 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 (97.990036010742): ( 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 (71.76399230957): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (44.107437133789): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (82.969665527344): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (43.153762817383): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (55.789947509766): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (526.90505981445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (524.99771118164): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (45.7763671875): SELECT name FROM jos_deeppockets WHERE id=213

136 (29.802322387695): SELECT name FROM jos_deeppockets WHERE id=213

137 (644.92225646973): 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

138 (590.08598327637): 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

139 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

140 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

141 (!!!!! 20010.948181152): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 1332.9982757568): 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=294744609 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (105.14259338379): 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=294744609 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (!!!!! 2348.1845855713): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

147 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

148 (!!!!! 1730.9188842773): 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

149 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

150 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

151 (87.02278137207): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294744609 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294744609 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (48.160552978516): 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)

153 (41.007995605469): 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)

154 (61.988830566406): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (436.06758117676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

156 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294744609 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294744609 AND published='1' LIMIT 1

157 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

158 (289.9169921875): select jos_facebook.link from jos_facebook where cat=10

159 (45.061111450195): select jos_google_plus.link from jos_google_plus where cat=10

160 (39.815902709961): select jos_linkedin.link from jos_linkedin where cat=10

161 (!!!!! 1947.1645355225): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 2474.0695953369): insert into jos_banners_delta values (14615,'2025-06-20 12:12:08','216.73.216.120','view'),(14202,'2025-06-20 12:12:08','216.73.216.120','view'),(14203,'2025-06-20 12:12:08','216.73.216.120','view')

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