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High-Resolution CT Screening for Lymphangioleiomyomatosis in Women with Collapsed Lung is Cost-Effective

By MedImaging International staff writers
Posted on 07 Apr 2010

Researchers have found that using high-resolution computed tomography (HRCT) scans to screen for lymphangioleiomyomatosis (LAM) is cost-effective in nonsmoking women between 25 and 54 who come to the emergency room for the first time with a collapsed lung.

The study's findings have been published online in March 2010 ahead of print publication in the American Thoracic Society's (ATS) American Journal of Respiratory and Critical Care Medicine by investigators from the University of Cincinnati (OH, USA).

Pulmonary LAM is a rare but serious lung disease that occurs when smooth muscle tissue proliferates within the interstitium of the lung in the form of characteristic thin-walled lung cysts. Many patients present with shortness of breath, which is often misdiagnosed as asthma. But about one-third of LAM patients develop a spontaneous pneumothorax, or a collapsed lung, as the first major sign. But because of its rarity, LAM is rarely diagnosed immediately.

"Women with LAM who first experience spontaneous lung collapse will, on average, experience two more, but diagnosis doesn't usually occur until the second or third collapse, delaying treatment,” said Brent Kinder, M.D., assistant professor of medicine and director of the University of Cincinnati (OH, USA) Interstitial Lung Disease Center and an investigator in the study. "We thought that targeting screening to nonsmoking women in the age range of typical LAM development may help us identify the condition earlier and improve quality of life for these patients.”

Dr. Kinder and Jared Hagaman, M.D., clinical research fellow in pulmonary, critical care and sleep medicine, along with other University of Cincinnati colleagues in the department of medicine, developed a model to evaluate the cost-effectiveness of screening patients for LAM. Using U.S. representative data sources, researchers looked at rates of collapsed lung and prevalence of LAM in relation to age, gender, and smoking status. They compared the benefit and cost of using high-resolution CT screening following lung collapse for patients with LAM to no CT screening. Costs of testing and treatment were taken from 2007 Medicare data.

Approximately 5% of women who fit the "model patient” profile--a 30-year old, nonsmoking woman who comes into the emergency room with a spontaneous lung collapse--test positive for LAM. "Screening for LAM using a high-resolution CT, or three-dimensional X-ray of the lungs, is the most cost-effective strategy, with approximately [US]$32,000 per quality-adjusted life year gained,” said Dr. Kinder. "For comparison, hemodialysis, a standard benchmark for cost-effectiveness, costs about $50,000 per quality-adjusted life year gained. With this data, physicians will be able to intervene with therapies more quickly and enroll patients in clinical trials that may be able to slow progression of the disease.”

Furthermore, Dr. Kinder pointed out, HRCT screening adds a low amount of risk to the LAM-negative population with respect to added radiation. "We believe the benefits of testing outweigh any negative impact on patients without LAM. Additionally, there will be benefits of high-resolution CT scanning for those with diagnoses of lung diseases other than LAM [such as Langerhans cell histocytosis, lymphocytic interstitial pneumonitis, and others]. The radiation dose of high-resolution CT scans is approximately one-tenth that of conventional CT scans, and with newer technology the radiation exposure continues to decrease.”

Due to the sudden nature of pneumothoraces, and their relative rarity, a prospective study in this population is not practicable. But the current findings may have immediate bearing on current clinical practices. "We believe that this study is a useful example of the utility of modern decision analysis techniques to answer important questions in comparative effectiveness research. We believe that this study may change current best practices; particularly if we are successful in raising awareness among emergency room providers, who typically manage these subjects during their acute sentinel event,” said Dr. Kinder.

John Heffner, M.D., past president of the ATS believes that the study will change future guideline recommendations in how to treat patients presenting with pneumothorax. "According to this study, only 20 women presenting with an initial pneumothorax would need to be screened by high-resolution CT to identify one patient with LAM,” he said. "Early detection not only provides opportunities for prevention of subsequent pneumothoraces, but also allows patient counseling, family planning, lifestyle adjustments, and early enrollment in clinical trials that are investigating innovative therapies for what is now an untreatable and progressive disorder. The results from the study will inform clinical approaches for the management of patients with pneumothorax in the future. Clearly, not all patients or even all women who present with an initial pneumothorax should undergo HRCT scanning, but I believe that the impressive cost effectiveness demonstrated in this investigation will encourage future patients' guideline developers to recommend CT scanning for all nonsmoking woman between the ages of 25-54 years.”

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57 (!!!!! 1422.8820800781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

58 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

59 (!!!!! 3044.8436737061): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

60 (123.97766113281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

61 (139.95170593262): 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 (617.98095703125): SELECT fid FROM jos_deeppockets WHERE id=294728837 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728837 AND published='1' LIMIT 1

63 (71.048736572266): 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`

64 (67.949295043945): select jos_twitters.link from jos_twitters where cat=10

65 (33.855438232422): select jos_facebook.link from jos_facebook where cat=10

66 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

67 (82.969665527344): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 2978.0864715576): SELECT fid FROM jos_deeppockets WHERE id=294728837 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728837 AND published='1' LIMIT 1

69 (92.029571533203): 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`

70 (436.06758117676): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (309.94415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.982040405273): 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 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (66.041946411133): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (81.062316894531): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (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`

90 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (102.04315185547): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (69.141387939453): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

105 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

106 (64.849853515625): 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=294728837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (669.00253295898): 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=294728837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3581.0470581055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

109 (125.88500976562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

110 (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.id=294728837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (633.95500183105): 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=294728837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (799.89433288574): 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 (!!!!! 1147.0317840576): 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 (!!!!! 2719.8791503906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

115 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

116 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

117 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

118 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

119 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

120 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

121 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

122 (385.99967956543): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 51321.983337402): 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 (!!!!! 1755.952835083): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728837 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728837 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 21715.879440308): ( 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 (370.02563476562): ( 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 (154.01840209961): 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 (360.96572875977): 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 (135.89859008789): 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 (322.81875610352): 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 (!!!!! 1147.985458374): 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 (137.0906829834): 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 (271.08192443848): 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 (135.89859008789): 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 (497.81799316406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (410.07995605469): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=211

138 (38.14697265625): SELECT name FROM jos_deeppockets WHERE id=211

139 (690.93704223633): 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

140 (639.91546630859): 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 (90.837478637695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

142 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

143 (!!!!! 8033.0371856689): TRUNCATE TABLE jos_trademed_module

144 (184.05914306641): 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=294728837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (90.122222900391): 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=294728837 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (546.93222045898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (123.97766113281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

149 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

150 (!!!!! 1701.1165618896): 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 (133.99124145508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

152 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

153 (51.975250244141): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728837 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728837 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (36.001205444336): 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)

155 (34.093856811523): 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 (45.061111450195): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 3724.0982055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

158 (875.94985961914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728837 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728837 AND published='1' LIMIT 1

159 (84.877014160156): select jos_twitters.link from jos_twitters where cat=10

160 (38.862228393555): select jos_facebook.link from jos_facebook where cat=10

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

162 (38.14697265625): select jos_linkedin.link from jos_linkedin where cat=10

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