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Spinal Digital Subtraction Angiography Deemed to Be Safe and Effective

By MedImaging International staff writers
Posted on 27 Sep 2011

Radiologists have reviewed the patient records of 302 men and women who had a much-needed X-ray of the blood vessels near the spinal cord and found that the procedure, frequently feared for possible complications of stroke and kidney damage, is safe and effective.

Reporting in the journal Neurology online September 14, 2011, the Johns Hopkins University (Baltimore, MD, USA) researchers found that none of the study participants, all of whom underwent a spinal digital subtraction angiography (SpDSA) at Johns Hopkins Hospital between 2000 and 2010, had suffered either a stroke or kidney damage as a result of the procedure, considered the “gold standard” modality for differentiating among many types of vascular disorders near the spine. These include strokes, hematomas, aneurysms, fistulas, and tumors.

“Patients and their physicians can now look with confidence to our study and see for themselves the real as opposed to perceived risks and complications from spinal angiography,” said study senior investigator and interventional neuroradiologist Philippe Gailloud, MD, “Advances in the procedure have made it much safer today than before, and neurologists and patients really should consider this valuable diagnostic tool based on the actual medical evidence and not on whatever unsubstantiated rumors they might hear secondhand or read on the Internet,” added Dr. Gailloud, an associate professor at the Johns Hopkins University School of Medicine.

Dr. Gailloud noted that reports of stroke and kidney damage had been rather high, in as many as 3% of people, in the 1970s when the procedure was first introduced. Then, preparing patients for testing and injecting a dye to make the blood vessels more visible frequently took hours instead of the routine half-hour it now takes, increasing the chances that a clot could dislodge in the blood vessels and cause a stroke. The earlier process also used up more than twice as much of the potentially toxic contrast agent than is needed today.

Another major finding in the latest study was that spinal angiography could accurately rule out suspected cases of spinal inflammation, a condition known as transverse myelitis. Fourteen of 45 patients diagnosed and treated with steroids or other immune-suppressing drugs for transverse myelitis were later confirmed by SpDSA to have a vascular malformation instead. All of these patients were successfully treated for their actual spinal problem, and none of them suffered any complications as a result.

According to Dr. Gailloud, who is also director of interventional neuroradiology at Johns Hopkins, this demonstrates physicians that anyone who is diagnosed with transverse myelitis and who does not show improvement after drug treatment but is still probably suffering from a spinal problem should consider having a SpDSA to either confirm the original diagnosis or determine if it is in reality a vascular malformation. Both conditions have similar symptoms, he reported, with people often complaining of a weakening in the legs, even temporary paralysis, sudden and uncontrolled urination, and back pain.

Lead study investigator and Hopkins medical student James Chen, MSc, began the study with encouragement from experts at the Johns Hopkins Transverse Myelitis Center after noticing continued reluctance by other specialists and patients to use spinal angiography. They believed the procedure to be too dangerous, despite growing acceptance of its efficacy. “To counter medical rumor and historical perception, we simply had to put some current numbers on its safety and risk,” stated Mr. Chen, who is also a research fellow in interventional neuroradiology at Johns Hopkins.

The investigators have already started the next phase of their research, a prospective study to track people after they have had a SpDSA for any possible complications months or even years after the procedure. Initial results are expected in 2012.

In the SpDSA procedure, a catheter tube is inserted into the larger blood vessels near the groin and gently threaded, one by one, into each of the major arteries branching from the aorta to the spine. Dye is released into each artery to help form multiple images of each artery, as taken by X-ray. The test is typically performed to identify specifically the source of the vascular problem after a magnetic resonance imaging (MRI) scan has ruled out any other physical disorders to the spine.

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59 (!!!!! 6948.9479064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

60 (!!!!! 7987.9760742188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

61 (!!!!! 8024.2156982422): 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 (!!!!! 4776.0009765625): SELECT fid FROM jos_deeppockets WHERE id=294737300 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737300 AND published='1' LIMIT 1

63 (!!!!! 2789.9742126465): 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 (!!!!! 6983.0417633057): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 8452.8923034668): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 7904.052734375): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 6740.0932312012): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 2851.0093688965): SELECT fid FROM jos_deeppockets WHERE id=294737300 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737300 AND published='1' LIMIT 1

69 (!!!!! 6871.9387054443): 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 (!!!!! 2063.9896392822): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (397.92060852051): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (49.829483032227): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 5034.9235534668): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (417.94776916504): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (260.1146697998): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (234.12704467773): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (276.08871459961): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 2244.9493408203): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (385.04600524902): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (516.89147949219): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (36.954879760742): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (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`

90 (400.06637573242): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (175.95291137695): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (823.02093505859): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (183.10546875): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (154.01840209961): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (150.91896057129): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2861.0229492188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

105 (209.09309387207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

106 (!!!!! 2504.825592041): 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=294737300 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (975.8472442627): 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=294737300 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (542.16384887695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

109 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

110 (821.82884216309): 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=294737300 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (922.91831970215): 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=294737300 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (687.83760070801): 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 (536.91864013672): 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 (!!!!! 1135.8261108398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

115 (!!!!! 2435.9226226807): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

116 (!!!!! 4363.0599975586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

117 (!!!!! 8613.109588623): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

118 (!!!!! 5609.9891662598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

119 (545.97854614258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

120 (!!!!! 1552.8202056885): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

121 (514.98413085938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

122 (425.10032653809): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 63753.128051758): 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 (!!!!! 14666.080474854): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737300 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737300 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1612.9016876221): ( 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 (!!!!! 2259.0160369873): ( 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 (!!!!! 1937.8662109375): 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 (936.03134155273): 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 (487.08915710449): 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 (!!!!! 3853.0826568604): 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 (!!!!! 1098.1559753418): 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 (678.06243896484): 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 (364.06517028809): 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 (108.95729064941): 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 (!!!!! 2595.9014892578): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1513.0043029785): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (895.97702026367): SELECT name FROM jos_deeppockets WHERE id=211

138 (56.982040405273): SELECT name FROM jos_deeppockets WHERE id=211

139 (928.87878417969): 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 (720.97778320312): 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 (!!!!! 2782.1063995361): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

142 (!!!!! 2501.0108947754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

143 (!!!!! 24281.024932861): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1338.005065918): 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=294737300 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 2496.0041046143): 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=294737300 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2214.9085998535): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (!!!!! 1005.1727294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2691.9841766357): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

149 (493.04962158203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

150 (!!!!! 5620.002746582): 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 (!!!!! 1495.8381652832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

152 (744.81964111328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

153 (!!!!! 1628.8757324219): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737300 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737300 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2140.998840332): 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 (110.14938354492): 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 (!!!!! 4527.0919799805): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1142.0249938965): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

158 (110.86463928223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737300 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737300 AND published='1' LIMIT 1

159 (!!!!! 2903.938293457): select jos_twitters.link from jos_twitters where cat=10

160 (234.84230041504): select jos_facebook.link from jos_facebook where cat=10

161 (185.01281738281): select jos_google_plus.link from jos_google_plus where cat=10

162 (166.89300537109): select jos_linkedin.link from jos_linkedin where cat=10

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