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CT Scans Reveal H7N9 Pneumonia Different from Other Strains

By MedImaging International staff writers
Posted on 25 Jul 2013

H7N9 pneumonia is characterized by imaging findings that differentiate it from other types of pneumonia, including rapidly progressive changes in the lungs and pulmonary connective tissues, according to the first study to describe radiologic findings in the disease.

The study’s findings were published on July 2, 2013, online in the journal Radiology. “The severity of these findings is associated with the severity of the clinical condition of the patients,” said study coauthor Zhiyong Zhang, MD, PhD, from the department of radiology at Shanghai Public Health Clinical Center and Shanghai Medical College of Fudan University (China).

H7N9 is a recently discovered subtype of avian influenza virus, also known as “bird flu.” Cases of bird flu infection in humans typically result from direct or close contact with infected poultry, such as domesticated chickens, pigeons, or ducks, or surfaces contaminated with secretions and excretions from infected birds. The first human outbreak of H7N9 was reported in China in March 2013. This new strain in humans has caused severe and rapidly progressing respiratory illness. H7N9 can cause acute respiratory distress syndrome, organ failure, and death.

Dr. Zhang and colleagues, for the study, evaluated the clinical data and radiologic files of 12 patients with avian-origin influenza A H7N9 virus who were admitted to Shanghai Public Health Clinical Center between April 3, 2013, and April 20, 2013. The 12 patients included nine men and three women, 47 to 81 years old (mean age, 66 years).

None of the patients raised pigeons or lived in or near a pigeon-infested area. One patient kept chickens at home, and four patients had gone to various farmers’ markets before the symptom onset. All other patients had no clear history of exposure to poultry. All patients exhibited fever with temperature of 38–40 °C, cough, shortness of breath, and white phlegm and loss of strength at the onset of the disease or within one week. They quickly progressed to severe pneumonia and acute respiratory distress syndrome.

The intervals between the onset of symptoms and the first imaging examinations ranged from one to six days for chest X-rays and two to nine days for computed tomography (CT) imaging. Chest X-rays were taken every one or two days thereafter to monitor disease progression and treatment response. To assess disease progression and possible complications, 10 of the patients underwent follow-up computed tomography (CT) two to eight days after initial examination.

The imaging findings included ground-glass opacity (a hazy area in the lungs with the appearance of ground glass) in all 12 patients, consolidations (regions of lung tissue filled with liquid) in 11 patients, air bronchograms (air-filled bronchi that are visible by swelling in neighboring tissues) in 11 patients, and interlobular septal thickening (thickening of pulmonary connective tissue) in 11 patients. Lung lesions involved three or more lobes in all cases, but were mostly detected in right lower lobe. Follow-up CT imaging in 10 patients showed interval improvement of the lesions in three patients and worsening of the lesions in seven patients. Imaging findings closely mirrored the overall clinical severity of the disease.

“The distribution and very rapid progression of consolidations, ground-glass opacity, and air bronchograms, with interstitial changes, in H7N9 pneumonia help differentiate it from other causes of pneumonia,” Dr. Zhang said.

Whereas these imaging characteristics are comparable to those found in other respiratory diseases, such as H1N1, H5N1 and severe acute respiratory syndrome (SARS), there are differences. “Both H1N1 pneumonia and SARS distribute more peripherally, with more changes in the spaces between tissues, and progress less rapidly than H7N9,” Dr. Zhang said. “In our study, the right lower lung was most likely to be involved, while there’s no lobar predilection in findings of H5N1 influenza.”

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60 (465.15464782715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

61 (819.20623779297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

62 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

63 (!!!!! 16419.172286987): 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

64 (611.0668182373): SELECT fid FROM jos_deeppockets WHERE id=294747427 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747427 AND published='1' LIMIT 1

65 (900.0301361084): 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`

66 (647.06802368164): select jos_twitters.link from jos_twitters where cat=10

67 (60.081481933594): select jos_facebook.link from jos_facebook where cat=10

68 (!!!!! 2556.0855865479): select jos_google_plus.link from jos_google_plus where cat=10

69 (59.127807617188): select jos_linkedin.link from jos_linkedin where cat=10

70 (!!!!! 3063.9171600342): SELECT fid FROM jos_deeppockets WHERE id=294747427 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747427 AND published='1' LIMIT 1

71 (123.02398681641): 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`

72 (993.01338195801): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (456.09474182129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (!!!!! 1982.9273223877): 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`

75 (915.0505065918): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (133.99124145508): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (264.16778564453): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (113.96408081055): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (370.02563476562): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (545.02487182617): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (266.07513427734): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (!!!!! 3568.172454834): 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`

92 (946.99859619141): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (75.101852416992): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (807.04689025879): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 3442.0490264893): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

107 (371.93298339844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

108 (!!!!! 5990.9820556641): 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=294747427 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 7907.8674316406): 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=294747427 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 3896.951675415): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

111 (648.97537231445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

112 (110.86463928223): 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=294747427 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (756.02531433105): 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=294747427 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 6365.0608062744): 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

115 (884.05609130859): 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 (998.02017211914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

117 (382.90023803711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

118 (787.01972961426): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

119 (532.15026855469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

120 (600.09956359863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

121 (258.9225769043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

122 (268.93615722656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

123 (180.00602722168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

124 (!!!!! 3823.0419158936): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 68462.84866333): 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

126 (!!!!! 1194.953918457): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747427 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747427 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 26713.132858276): ( 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

128 (81.062316894531): ( 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 (73.909759521484): 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

130 (50.067901611328): 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 (635.14709472656): 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

132 (60.081481933594): 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 (532.15026855469): 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

134 (61.03515625): 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 (722.88513183594): 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

136 (63.896179199219): 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 (!!!!! 9948.9688873291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (749.82643127441): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (433.92181396484): SELECT name FROM jos_deeppockets WHERE id=211

140 (62.942504882812): SELECT name FROM jos_deeppockets WHERE id=211

141 (920.05729675293): 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

142 (790.83442687988): 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 (!!!!! 3219.8429107666): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

144 (105.85784912109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

145 (!!!!! 17233.848571777): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 9950.1609802246): 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=294747427 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (951.05171203613): 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=294747427 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (600.09956359863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (201.94053649902): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (!!!!! 2323.8658905029): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

151 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

152 (!!!!! 4578.1135559082): 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

153 (591.99333190918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

154 (494.95697021484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

155 (679.96978759766): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747427 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747427 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (897.88436889648): 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)

157 (61.03515625): 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 (!!!!! 3037.9295349121): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (150.91896057129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

160 (!!!!! 3705.9783935547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747427 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747427 AND published='1' LIMIT 1

161 (128.03077697754): select jos_twitters.link from jos_twitters where cat=10

162 (53.167343139648): select jos_facebook.link from jos_facebook where cat=10

163 (!!!!! 3602.0278930664): select jos_google_plus.link from jos_google_plus where cat=10

164 (123.02398681641): select jos_linkedin.link from jos_linkedin where cat=10

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