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CT System May Reduce Number of Revision Sinus Surgeries

By MedImaging staff writers
Posted on 10 Jun 2008

In the operating room (OR), a surgeon's assessment of disease is limited without access to sophisticated imaging techniques. More...

A decision of whether revision surgery may be necessary occurs post-surgery with the assistance of diagnostic images, or computed tomography (CT) scans. While the possibility of multiple surgeries may be disturbing to sinus patients, the risk of those revision surgeries is about to be dramatically reduced.

A team of ear, nose, and throat surgeons (ENT) at the University of Pennsylvania (UPenn; Philadelphia, PA, USA) set out to demonstrate that the use of a unique, small and literally mobile CT scanner, called xCAT ENT, will decrease those percentages significantly, making them a statistic of the past. Those surgeons revealed that use of xCAT ENT in the OR led to alteration in the surgical plan in 30% of patients.

Tailoring this to an individual, without xCAT ENT, there is a 30% chance of some disease being left, even in the hands of the most experienced surgeons, and therefore a greater chance of needing to undergo additional surgery. "We believe that it is very important to avoid leaving pockets of disease during sinus surgery and this is a significant advance in terms of making sure the surgery is complete,” said David W. Kennedy, M.D. a professor in the UPenn department of otorhinolaryngology: head and neck surgery. The study was published in the April 2008 issue of the American Journal of Rhinology.

Surgeries are performed using CT scans of the patient taken days or weeks before the operation. Since the anatomy of the patient is changing during surgery and the surgery is performed close to the eye and to the brain, surgeons walk a fine line between leaving disease, and at the same time, minimizing the risks to these vital areas. The surgery itself reduces the accuracy and usefulness of those CT scans as blueprints for the surgeon. The result is that surgeons who are unable to see beyond the surgically explored area may frequently leave disease during the surgery.

To see beyond the region, the surgeon needs real-time updated images of surgical anatomy, specifically in complex surgeries close to the brain, which require extreme accuracy. Before the development of this system, there was almost no way to CT scan during surgery. Big immobile hospital scanners could not be used in the operating room and patients could not be wheeled down to central imaging in the middle of a surgery. xCAT ENT supplied surgeons that all-desirable updated CT scan while in surgery.

The team of researchers at U Penn began to see a pattern. The uniquely designed mobile xCAT ENT has a surgical advantage: it became an extra set of eyes for the surgeon in the operating room, allowing the surgeon to see beyond those areas surgically explored. With a set of fresh blueprints, the surgeons were able to make final surgical corrections instead of prematurely closing patients.

The mobile xCAT was developed by Xoran Technologies (Ann Arbor, MI, USA), a biotechnology company founded in 2001 by two University of Michigan (An Arbor, USA) research scientists. Xoran is a developer of ultra compact, low-dose CT scanners for imaging highly specific areas of a patient's head.

To develop xCAT ENT, Xoran shrunk CT technology into an ultra portable device, a fraction of the size of a full-body scanner and about 1/10 the weight. The distinctive scanner is very compact, easily wheeled directly to the patient on the operating table, and quickly provides CT images in the OR. Because ORs are tight, the size, turning radius, and ease of use are vital.

The study by the ENT surgeons at UPenn established that the ability to perform a "report card” scan at the end of surgery allowed the surgeon to make final surgical corrections instead of prematurely closing the patient. Even in the hands of those surgeons who are the most skilled in performing this surgery, xCAT ENT presented a pathway to performing additional necessary surgery before the patient awoke in 30% of operations.

This study should affect a sizable percentage of those individuals troubled with sinus disease that requires surgery, potentially allowing them to move on with their lives--instead of returning to hospitals for additional and painful operations. The investigators concluded that this currently available technology has the potential to improve the extent of surgery in patients with complicated anatomy and extensive disease.

Related Links:
University of Pennsylvania
Xoran Technologies

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58 (!!!!! 1096.9638824463): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

59 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

60 (94.175338745117): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

61 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

62 (74.863433837891): 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

63 (559.09156799316): SELECT fid FROM jos_deeppockets WHERE id=285250000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=285250000 AND published='1' LIMIT 1

64 (49.829483032227): 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=211 ORDER BY `ordering`

65 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

66 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

67 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

68 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

69 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE id=285250000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=285250000 AND published='1' LIMIT 1

70 (30.994415283203): 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=211 ORDER BY `ordering`

71 (293.97010803223): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (205.99365234375): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (41.961669921875): 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`

74 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (60.796737670898): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (33.855438232422): 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`

91 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

106 (42.200088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

107 (49.114227294922): 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=285250000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (46.968460083008): 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=285250000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

110 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

111 (56.028366088867): 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=285250000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (485.89706420898): 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=285250000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (568.86672973633): 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 (320.9114074707): 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 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

116 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

117 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

118 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

119 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

120 (35.04753112793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

121 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

122 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

123 (238.89541625977): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 19093.036651611): 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

125 (501.87110900879): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285250000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285250000 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 7390.9759521484): ( 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 (97.036361694336): ( 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 (63.180923461914): 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 (41.007995605469): 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 (62.942504882812): 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 (40.769577026367): 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 (377.89344787598): 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 (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

134 (42.915344238281): 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 (36.001205444336): 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 (437.02125549316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (301.83792114258): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=211

139 (32.901763916016): SELECT name FROM jos_deeppockets WHERE id=211

140 (516.89147949219): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (477.07557678223): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

143 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

144 (!!!!! 7884.0255737305): TRUNCATE TABLE jos_trademed_module

145 (84.161758422852): 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=285250000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (55.074691772461): 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=285250000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (803.94744873047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

150 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

151 (!!!!! 1094.1028594971): 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

152 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

153 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

154 (41.961669921875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285250000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285250000 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (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=211 or channel_id is null)

156 (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=211 or channel_id is null)

157 (46.014785766602): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

159 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285250000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285250000 AND published='1' LIMIT 1

160 (44.107437133789): select jos_twitters.link from jos_twitters where cat=10

161 (36.001205444336): select jos_facebook.link from jos_facebook where cat=10

162 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

163 (42.200088500977): select jos_linkedin.link from jos_linkedin where cat=10

164 (312.08992004395): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 2656.9366455078): insert into jos_banners_delta values (14615,'2025-08-24 17:26:33','216.73.216.171','view'),(14202,'2025-08-24 17:26:33','216.73.216.171','view'),(14203,'2025-08-24 17:26:33','216.73.216.171','view')

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