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Lung Cancer CT Screening May Be Helpful in Detecting COPD

By MedImaging International staff writers
Posted on 08 Nov 2011

Among men who were current or former heavy smokers, undergoing lung cancer screening with computed tomography (CT) scanning detected a considerable percentage who had chronic obstructive pulmonary disease (COPD), suggesting that this modality may be beneficial as an additional application in detecting COPD, according to recent research.

The study’s findings were published in the October 26, 2011, issue of the Journal of the American Medical Association (JAMA). “Smoking is annually projected to cause more than eight million deaths worldwide in the coming decades. Besides cardiovascular disease and cancer, chronic obstructive pulmonary disease is a major cause of death in heavy smokers. Nevertheless, COPD is considerably underdiagnosed. In spite of a decrease in cardiovascular mortality and stabilization of cancer mortality worldwide, mortality from COPD is increasing,” according to the authors. Early termination of smoking can prevent COPD progression, highlighting the importance of early detection. CT-based lung cancer screening may provide an opportunity to detect individuals with COPD at an early stage.

Onno M. Mets, MD, from the University Medical Center Utrecht (The Netherlands), and colleagues conducted a study to explore whether low-dose lung cancer screening CT scans could be utilized to identify participants with COPD. The study, performed within an ongoing lung cancer screening trial, included prebronchodilator pulmonary function testing with inspiratory and expiratory CT scans performed on the same day from 1,140 male study participants between July 2007 and September 2008. The pulmonary function tests were used as the reference standard in determining the COPD diagnostic accuracy of the CT scans.

The average age of participants was 62.5 years. Data for self-reported respiratory symptoms were available from 1,085 participants; a total of 566 participants were symptomatic, and 519 participants were asymptomatic. Forty-one participants (3.6%) reported physician-diagnosed emphysema and 93 (8.2%), bronchitis. Based on the results of pulmonary function testing, 437 participants (38%) were classified as having COPD.

The final diagnostic model for the study included five factors independently associated with obstructive pulmonary disease: CT emphysema, CT air trapping (an abnormal retention of air in the lungs), body mass index, pack-years (the number of packs of cigarettes smoked per day multiplied by the number of years the person has smoked), and smoking status. Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63%, a specificity of 88%, and a positive predictive value of 76%, which corresponds to 63% (274 of 437) of all participants with COPD. These 274 participants comprised 54% (150 of 277) of all participants with mild obstruction, 73% (99 of 135) of all participants with moderate obstruction, and 100% (25 of 25) of all participants with severe obstruction.

“Our study findings suggest several practical considerations. If the results of this study are validated and confirmed and are found to be generalizable, it may be reasonable to consider adding an expiratory CT scan to the [baseline] inspiratory CT scan for additional evaluation of COPD because this would improve diagnostic accuracy. Although an additional ultralow-dose expiration CT scan increases the radiation dose, this exposure is limited. The additional scan can be obtained within the five minutes needed for lung cancer screening, so a substantial amount of extra scan time is not required,” the authors wrote.

The researchers added that this possible approach of using quantitative CT for detection of airflow limitation is not suggested as a primary screening method for COPD, for which pulmonary function testing is the preferred method. “A screening test should have a high sensitivity to identify most of the participants with unsuspected disease, and the performance of our strategy at optimal accuracy is not sufficient for CT to serve as a COPD screening test.”

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62 (772.95303344727): SELECT fid FROM jos_deeppockets WHERE id=294737938 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737938 AND published='1' LIMIT 1

63 (407.93418884277): 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 (75.101852416992): select jos_twitters.link from jos_twitters where cat=10

65 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

66 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

67 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

68 (55.074691772461): SELECT fid FROM jos_deeppockets WHERE id=294737938 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737938 AND published='1' LIMIT 1

69 (35.04753112793): 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 (415.08674621582): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (319.9577331543): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (50.067901611328): 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 (75.817108154297): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (35.04753112793): 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 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (68.187713623047): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

105 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

106 (61.03515625): 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=294737938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (745.05805969238): 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=294737938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2410.1734161377): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

109 (141.14379882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

110 (170.94612121582): 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=294737938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (939.13078308105): 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=294737938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (684.02290344238): 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 (548.8395690918): 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 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

115 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

116 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

117 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

118 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

119 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

120 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

121 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

122 (389.81437683105): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 51210.165023804): 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 (771.04568481445): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737938 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737938 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 16927.95753479): ( 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 (178.09867858887): ( 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 (769.13833618164): 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 (61.988830566406): 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 (818.01414489746): 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 (51.975250244141): 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 (336.88545227051): 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 (459.90943908691): 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 (772.95303344727): 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 (50.067901611328): 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 (!!!!! 1101.016998291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (789.88075256348): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (924.11041259766): SELECT name FROM jos_deeppockets WHERE id=211

138 (66.995620727539): SELECT name FROM jos_deeppockets WHERE id=211

139 (941.99180603027): 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 (848.05488586426): 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 (!!!!! 1536.8461608887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

142 (656.8431854248): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

143 (!!!!! 18537.044525146): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 5658.8649749756): 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=294737938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (154.01840209961): 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=294737938 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1954.0786743164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

149 (394.10591125488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

150 (!!!!! 4194.0212249756): 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 (484.94338989258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

152 (625.1335144043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

153 (912.18948364258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737938 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737938 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (288.96331787109): 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 (50.067901611328): 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 (838.04130554199): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 5768.0606842041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

158 (!!!!! 3518.1045532227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737938 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737938 AND published='1' LIMIT 1

159 (71.048736572266): select jos_twitters.link from jos_twitters where cat=10

160 (613.92784118652): select jos_facebook.link from jos_facebook where cat=10

161 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

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