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Changes in Lungs Associated with COPD Flare-Ups Revealed by CT

By MedImaging International staff writers
Posted on 15 Aug 2011

Image: Computed Tomography (CT) scan in axial section of the lungs in an adult patient, showing chronic obstructive pulmonary disease (COPD) with centrilobular emphysema (Photo courtesy of Michel Brauner / ISM).

Using computed tomography (CT) imaging, researchers have identified two types of structural changes in the lungs of patients with chronic obstructive pulmonary disease (COPD) that are associated with frequent exacerbations, or episodes when symptoms suddenly worsen.

The investigators’ findings were published online July 2011 in the journal Radiology.

COPD can damage both the airways and the air sacs of the lungs, and is a leading cause of death and illness worldwide. The two main structural abnormalities seen in COPD are emphysema, in which the air sacs of the lung are gradually destroyed, and airway disease, which causes a narrowing of the bronchial tubes. “COPD is an extremely common problem that is frustrating to physicians,” said the study’s lead researcher, MeiLan K. Han, MD, MS, assistant professor of medicine at the University of Michigan Health System (Ann Arbor, MI, USA). “For a long time, we have had a one-size-fits-all approach to treating COPD patients.”

COPD is currently staged by measuring lung function with a spirometer. A few medications are typically prescribed for the condition, regardless of what type of COPD patients have. “Spirometry is inadequate as the sole parameter for assessing risk of exacerbations,” Dr. Han said. “Two COPD patients may be identical in terms of lung function yet behave very differently. For instance, there are subsets of patients with severely reduced lung function who do not experience frequent exacerbations.”

According to the US National Heart, Lung and Blood Institute (NHLBI; Bethesda, MD, USA), an estimated US$49.9 billion was spent on COPD in the United States in 2010, the majority of which was related to exacerbations.

Dr. Han studied data from the COPDGene study, an ongoing multicenter NHLBI-sponsored study, designed to identify genetic factors associated with COPD. In the study, patients who are between 45 and 80 years old with a history of cigarette smoking undergo spirometry and whole-lung volumetric CT examinations. Dr. Han’s study group included the first 2,500 patients enrolled in the COPD Gene Study who met criteria for COPD. The researchers studied whether there was an association between a patient’s bronchial wall thickness and degree of air sac destruction on CT with frequency of exacerbations.

The analysis demonstrated that while many patients had a mixture of structural alterations related to their COPD, two subgroups predominantly with emphysema or large airway disease could be identified, and both increased airway wall thickness and increased emphysema were associated with greater exacerbation frequency, independent of spirometric measures of lung function. “Radiologic characterization of COPD patients has prognostic value in the selection of more homogeneous subgroups for clinical trials and possibly for identifying patients at risk of frequent exacerbations for targeted medical therapies,” Dr. Han said.

Dr. Han added that her study suggests there may be different disease processes causing inflammation in the two COPD subgroups, and that future research may help determine if these patients should be treated differently.

Related Links:
University of Michigan Health System
US National Heart, Lung and Blood Institute

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63 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

64 (93.936920166016): 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 (540.97175598145): SELECT fid FROM jos_deeppockets WHERE id=294736577 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736577 AND published='1' LIMIT 1

66 (44.107437133789): 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 (40.054321289062): select jos_twitters.link from jos_twitters where cat=10

68 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

69 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

70 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

71 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=294736577 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736577 AND published='1' LIMIT 1

72 (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`

73 (300.16899108887): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (287.05596923828): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (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`

76 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (71.048736572266): 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 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (!!!!! 1430.9883117676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

108 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

109 (54.121017456055): 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=294736577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (50.067901611328): 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=294736577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (79.154968261719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

112 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

113 (47.922134399414): 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=294736577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (580.0724029541): 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=294736577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (614.88151550293): 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 (375.03242492676): 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 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

118 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

119 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

120 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

121 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

122 (34.809112548828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

123 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

124 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

125 (339.98489379883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

126 (!!!!! 24610.042572021): 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 (583.17184448242): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736577 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736577 AND type='deeppockets_item' AND published='1' LIMIT 1

128 (56.028366088867): ( 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 (51.021575927734): ( 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 (34.809112548828): 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 (30.040740966797): 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 (36.001205444336): 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 (29.087066650391): 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 (27.894973754883): 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 (29.087066650391): 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 (29.087066650391): 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 (30.994415283203): 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 (498.05641174316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (361.91940307617): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (90.122222900391): SELECT name FROM jos_deeppockets WHERE id=211

141 (44.822692871094): SELECT name FROM jos_deeppockets WHERE id=211

142 (628.94821166992): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (499.01008605957): 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 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

145 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

146 (!!!!! 8590.9366607666): TRUNCATE TABLE jos_trademed_module

147 (178.81393432617): 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=294736577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (102.04315185547): 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=294736577 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (834.94186401367): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

152 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

153 (!!!!! 1226.9020080566): 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 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

155 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

156 (37.908554077148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736577 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736577 AND type='deeppockets_item' AND published='1' LIMIT 1

157 (42.915344238281): 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 (96.08268737793): 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 (51.021575927734): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

160 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

161 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736577 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736577 AND published='1' LIMIT 1

162 (70.095062255859): select jos_twitters.link from jos_twitters where cat=10

163 (46.968460083008): select jos_facebook.link from jos_facebook where cat=10

164 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

165 (42.200088500977): select jos_linkedin.link from jos_linkedin where cat=10

166 (279.90341186523): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

167 (!!!!! 1218.0805206299): insert into jos_banners_delta values (14615,'2025-08-20 01:44:21','216.73.216.0','view'),(14202,'2025-08-20 01:44:21','216.73.216.0','view'),(14203,'2025-08-20 01:44:21','216.73.216.0','view')

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