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CT Scans Could Help Predict Early Death in Diabetics

By MedImaging International staff writers
Posted on 15 Jun 2011

New findings reveal that common imaging technology may be useful in predicting early death in individuals with diabetes.

The study was published in the May 2011 issue of the journal Diabetes Care. "People with diabetes are already at high risk of developing heart disease and experiencing an early death," said Donald W. Bowden, PhD, the director of the Center for Diabetes Research at Wake Forest Baptist Medical Center (Winston-Salem, NC, USA) and lead investigator. "With this study, we've discovered that we can identify a subset of individuals within this high risk group who are at even higher risk, and the means to do this is already widely available in the form of a computed tomography [CT] scan--a relatively inexpensive and noninvasive test."

At least 60% of diabetes patients--even those on dialysis for kidney failure-- ultimately die of a vascular event, such as heart attack or stroke. However, according to Dr. Bowden, questions about why so many diabetes patients die early have remained unanswered in the medical community's understanding of the disease.

For the diabetes heart study, Dr. Bowden and colleagues have been following nearly 1,500 patients with diabetes in North Carolina for approximately 13 years, collecting data on various aspects of the disease and how it affects individual health. As original study participants began to die, the researchers sought to understand why.

"When we reviewed the data last year, we were shocked by the number of participants who had already died during this study," Dr. Bowden said. "We wanted to find out if there were any predictors of who would succumb versus those who are still living. In a group of people who are already at high risk, we were looking for a way to identify which individuals were at even higher risk for early death, with the goal of finding interventions or ways to focus medical care and attention toward those individuals at highest risk."

A high coronary artery calcium (CAC) score is known to be a strong indicator of coronary heart disease. The score provides a measure of how much coronary artery disease, or calcified plaque is present in the blood vessels of the heart. Plaque plays a major role in heart attacks and other vascular events, and can be measured by taking a special gated CT scan, which in comparison to typical CT scans, uses very few X-rays, does not require any injections, and typically takes less than 10 minutes to perform. At Wake Forest Baptist, the test costs just over US$200 and some insurance companies will cover the exam in appropriate situations.

Within the diabetes-affected population, there is a very wide range of calcified plaque buildup in the arteries and the heart, from individuals with none at all, to people whose entire vessels are nearly completely calcified. The researchers separated more than 1,000 study participants into five groups, according to the amount of calcified plaque they had in their blood vessels at the beginning of the study. The health of those participants was then followed for an average of 7.4 years before researchers compared the data from those who died during the study to those who are still living.

"We saw a dramatic risk of dying earlier in the people with highest levels of calcified plaque in their blood vessels," Dr. Bowden said. "When comparing the group with the highest amount of plaque to the group that had the lowest amount of calcified plaque, the risk of dying was more than six times greater in the group with high levels of calcified plaque. The difference in risk that we revealed is striking. It's in a group of people who are already at risk, but the CAC level really rather dramatically differentiates risk between people within this high risk group. This finding could have novel clinical implications."

Diabetes is associated with many other medical problems, according to Dr. Bowden, so identifying a way to determine who is at highest risk and who needs the most intensive medical monitoring and care is especially important. "The striking magnitude of the risk suggests very strongly that other research samples should be evaluated, especially in individuals with diabetes," he said.

Related Links:
Center for Diabetes Research at Wake Forest Baptist Medical Center

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61 (!!!!! 7020.9503173828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

62 (!!!!! 5300.9986877441): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

63 (329.01763916016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

64 (!!!!! 3860.9504699707): 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

65 (!!!!! 6484.0316772461): SELECT fid FROM jos_deeppockets WHERE id=294735590 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735590 AND published='1' LIMIT 1

66 (!!!!! 1692.0566558838): 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`

67 (!!!!! 1201.868057251): select jos_twitters.link from jos_twitters where cat=10

68 (!!!!! 2829.0748596191): select jos_facebook.link from jos_facebook where cat=10

69 (963.92631530762): select jos_google_plus.link from jos_google_plus where cat=10

70 (!!!!! 1269.1020965576): select jos_linkedin.link from jos_linkedin where cat=10

71 (!!!!! 2530.8132171631): SELECT fid FROM jos_deeppockets WHERE id=294735590 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735590 AND published='1' LIMIT 1

72 (206.94732666016): 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`

73 (!!!!! 1590.0135040283): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (204.08630371094): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (253.91578674316): 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`

76 (616.07360839844): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (192.88063049316): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (302.07633972168): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 3039.8368835449): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (169.03877258301): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (698.80485534668): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (130.89179992676): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (180.95970153809): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (!!!!! 3061.056137085): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (354.76684570312): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (800.84800720215): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (176.90658569336): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (91.075897216797): 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`

93 (!!!!! 2521.0380554199): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (185.01281738281): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (595.8080291748): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (182.15179443359): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (98.943710327148): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 1127.0046234131): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (337.12387084961): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (684.02290344238): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (267.98248291016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

108 (459.90943908691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

109 (156.87942504883): 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=294735590 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (752.92587280273): 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=294735590 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 8387.0887756348): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

112 (167.8466796875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

113 (593.18542480469): 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=294735590 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (817.06047058105): 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=294735590 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (!!!!! 3451.8241882324): 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 (!!!!! 3371.9539642334): 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

117 (545.97854614258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

118 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

119 (!!!!! 1914.9780273438): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

120 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

121 (394.82116699219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

122 (296.11587524414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

123 (334.02442932129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

124 (267.02880859375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

125 (!!!!! 1449.1081237793): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 66560.983657837): 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

127 (916.95785522461): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735590 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735590 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (!!!!! 27995.109558105): ( 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 (!!!!! 1438.1408691406): ( 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

130 (416.04042053223): 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 (118.01719665527): 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

132 (509.02366638184): 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 (108.95729064941): 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

134 (951.05171203613): 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 (58.174133300781): 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

136 (341.17698669434): 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 (342.84591674805): 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

138 (597.00012207031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (442.9817199707): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (63.896179199219): SELECT name FROM jos_deeppockets WHERE id=211

141 (38.862228393555): SELECT name FROM jos_deeppockets WHERE id=211

142 (764.13154602051): 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

143 (706.91108703613): 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

144 (!!!!! 3845.9300994873): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

145 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

146 (!!!!! 20348.072052002): TRUNCATE TABLE jos_trademed_module

147 (163.07830810547): 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=294735590 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (605.10635375977): 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=294735590 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (450.84953308105): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

152 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

153 (!!!!! 5384.9220275879): 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

154 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

155 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

156 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735590 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735590 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (32.901763916016): 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)

158 (30.040740966797): 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)

159 (!!!!! 2660.9897613525): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

161 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735590 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735590 AND published='1' LIMIT 1

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

163 (28.848648071289): select jos_facebook.link from jos_facebook where cat=10

164 (29.087066650391): select jos_google_plus.link from jos_google_plus where cat=10

165 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

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