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320-Detector CT Imaging as Effective as Invasive Tests to Evaluate Heart Blockages

By MedImaging International staff writers
Posted on 03 Dec 2013

An ultrafast, 320-detector computed tomography (CT) scanner that shows both anatomy within coronary arteries and blood flow can effectively decide which patients require or do not require an invasive procedure to identify coronary blockages, according to an international study. More...

The researchers reported that their findings could have the potential to save millions of people worldwide from having an unnecessary cardiac catheterization.

The study, known as CORE 320, involved 381 patients at 16 hospitals in eight countries. An article on the findings was published online November 19, 2013, in the European Heart Journal. In the study, participants were evaluated with a 320-detector CT and typically used tests that are now widely used. The researchers reported that 91% of those in whom the CT scan ruled out blockages would not have needed invasive treatment such as bypass surgery or stenting. Therefore, those patients, none of whom had a history of coronary artery disease, could have avoided invasive tests because for them the CT scan was just as effective in ascertaining who would be a good candidate for revascularization as the traditional testing.

“Ours is the first prospective, multicenter study to examine the diagnostic accuracy of CT for assessing blockages in blood vessels and determining which of those blockages may be preventing the heart from getting adequate blood flow,” said Joao A. C. Lima, MD, senior author of the study and a professor of medicine and radiology at the Johns Hopkins University School of Medicine (Baltimore, MD, USA). “We found an excellent correlation in results when we compared the 320-detector CT testing with the traditional means of assessment using a stress test with imaging and cardiac catheterization.”

According to Dr. Lima, the study findings, would apply to individuals suffering from chest pain but not a heart attack based on electrocardiogram (ECG) and other indications. Many people in that setting are sent to a cardiac catheterization laboratory for additional assessment with angiography, an invasive test to look for blockages in the coronary arteries using dye and special X-rays. Approximately 30% of patients who have such catheterization are found to have minimal disease or no blockage requiring an intervention to open the vessel with a stent or bypass the vessel through surgery, reported Dr. Lima.

The 381 patients who completed the study had traditional single-photon emission computed tomography (SPECT) imaging and invasive angiography. Dr. Lima reported that SPECT, a stress-type of test, shows reduced blood flow to the heart without indicating the number or specific location of blockages.

Study participants also had two types of tests with a noninvasive 320-detector CT scanner. In the first CT test, the scanner was used to see the anatomy of vessels to assess whether and where there were blockages. That test is known as CT angiography (CTA). Then, in a second CT test with the same machine, patients were given a medication that dilates blood vessels and increases blood flow to the heart in ways similar to what happens during a stress test. The second test is called CT perfusion (CTP).

“We found that the 320-detector CT scanner allowed us to see the anatomy of the blockages and determine whether the blockages were causing a lack of perfusion to the heart,” stated lead author Carlos E. Rochitte, M.D., a cardiologist at the InCor Heart Institute, University of Sao Paulo Medical School (Brazil), “We were therefore able to correctly identify the patients who needed revascularization within 30 days of their evaluation.”

“Many patients are sent for an angioplasty when they may not need it. Our ultimate goal is to have more certainty about which patients having chest pain—without evidence of a heart attack—need an invasive procedure to open an arterial blockage,” said cardiologist Dr. Richard George, MD, an associate professor of medicine at the Johns Hopkins University School of Medicine, and a coauthor of the study. “The CTP test added significant information about the patients’ conditions and boosted our ability to identify those whose blockages were severe enough to reduce blood flow to the heart,” added Dr. George, who developed the CTP method with Lima.

The 320-detector CT provides a wide-ranging picture of the heart by making just one revolution around the body. The researchers noted that the two tests combined, CTA and CTP, still generate less radiation than a scan with the 64-detector CT scanner in widespread use today. “In our study, the amount of radiation exposure to patients from the two 320-detector CT tests was half the amount they received as a result of the traditional evaluation methods--the angiogram and nuclear medicine stress test combined,” said Dr. Lima.

The researchers noted that they would continue to monitor the patients in the study for five years, searching for any heart-related events such as heart attacks, as well as hospital admissions, or procedures.

The study was sponsored by Toshiba Medical Systems Corp. (Tokyo, Japan).

Related Links:
Johns Hopkins University School of Medicine
InCor Heart Institute, University of São Paulo Medical School

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56 (!!!!! 2554.178237915): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1159.1911315918): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

59 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

60 (663.04206848145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

61 (!!!!! 1856.0886383057): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

62 (171.89979553223): 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

63 (469.20776367188): SELECT fid FROM jos_deeppockets WHERE id=294749468 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294749468 AND published='1' LIMIT 1

64 (!!!!! 6841.1827087402): 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`

65 (97.036361694336): select jos_twitters.link from jos_twitters where cat=10

66 (34.093856811523): select jos_facebook.link from jos_facebook where cat=10

67 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

68 (28.133392333984): select jos_linkedin.link from jos_linkedin where cat=10

69 (35.04753112793): SELECT fid FROM jos_deeppockets WHERE id=294749468 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294749468 AND published='1' LIMIT 1

70 (31.948089599609): 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`

71 (276.08871459961): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (286.10229492188): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (75.101852416992): 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`

74 (!!!!! 3489.9711608887): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (169.99244689941): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 1764.0590667725): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (339.03121948242): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (160.93254089355): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (161.88621520996): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1044.0349578857): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (570.05882263184): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (!!!!! 3390.0737762451): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (373.84033203125): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 3294.9447631836): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (138.0443572998): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 3872.1561431885): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (113.01040649414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (36.954879760742): 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`

91 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 4709.9590301514): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

106 (133.03756713867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

107 (95.129013061523): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (72.956085205078): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

110 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

111 (87.02278137207): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (504.97055053711): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (653.98216247559): 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 (416.04042053223): 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 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

116 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

117 (73.19450378418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

118 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

119 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

120 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

121 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

122 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

123 (347.13745117188): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 29086.112976074): 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

125 (547.88589477539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749468 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749468 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 9712.9344940186): ( 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 (154.01840209961): ( 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 (66.041946411133): 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 (42.915344238281): 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 (44.107437133789): 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 (28.848648071289): 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 (329.97131347656): 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 (63.896179199219): 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 (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

135 (28.133392333984): 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 (553.13110351562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (379.08554077148): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (39.815902709961): SELECT name FROM jos_deeppockets WHERE id=211

139 (34.093856811523): SELECT name FROM jos_deeppockets WHERE id=211

140 (731.9450378418): 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 (666.14151000977): 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 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

143 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

144 (!!!!! 9850.025177002): TRUNCATE TABLE jos_trademed_module

145 (87.976455688477): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (58.889389038086): 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=294749468 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (860.92948913574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

150 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

151 (!!!!! 1266.0026550293): 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

152 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

153 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

154 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294749468 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294749468 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (34.093856811523): 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 (32.901763916016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

157 (35.04753112793): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

159 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294749468 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294749468 AND published='1' LIMIT 1

160 (44.822692871094): select jos_twitters.link from jos_twitters where cat=10

161 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

162 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

163 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

164 (502.8247833252): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 1101.016998291): insert into jos_banners_delta values (14615,'2025-08-19 04:42:52','216.73.216.0','view'),(14202,'2025-08-19 04:42:52','216.73.216.0','view'),(14203,'2025-08-19 04:42:52','216.73.216.0','view')

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