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Significant Benefits Seen for Critically Ill Patients Undergoing Contrast-Enhanced Echocardiography

By MedImaging International staff writers
Posted on 22 Apr 2009

A large, retrospective study has demonstrated that use of contrast-enhanced echocardiography was associated with a significantly improved short-term survival among critically ill, intensive care unit (ICU) patients, when compared with matched patients receiving noncontrast echocardiography.

The study's findings were presented at the 58th annual scientific sessions of the American College of Cardiology held in Orlando, FL, USA, in March 2009. Patients who received contrast exhibited a 26% lower risk of short-term mortality within 48 hours after the exam when compared with patients who received echocardiography without the ultrasound contrast agent. Transthoracic echocardiography, the most common type of echocardiogram, uses a transducer on a person's chest to send high frequency ultrasound waves through the chest wall to the heart to generate images of the heart that physicians can then analyze. A new contrast agent comprised of lipid microspheres was used to improve the images of suboptimal noncontrast echocardiograms.

These recent findings build on a recent multicenter 2008 retrospective study of over four million hospitalized patients that also demonstrated that echocardiography with Definity vial for injectable suspension (perflutren lipid microsphere), developed by Lantheus Medical Imaging, Inc. (North Billerica, MA, USA), was associated with a lower risk of short-term mortality in comparison with patients undergoing non-Definity echocardiograms.

"The data demonstrate a significantly lower risk of short-term mortality among critically ill patients receiving contrast-enhanced echocardiograms and affirm the clinical value of echocardiogram contrast agents as an important diagnostic tool for specialized patient populations," said Michael L. Main, M.D., associate professor of medicine, University of Missouri (Kansas City, USA); director, echocardiography laboratory, Saint Luke's Mid America Heart Institute (Kansas City, MO, USA) and lead author on the study. "Given the limited diagnostic options for critically ill patients, we are encouraged by these results that demonstrate the survival benefit of contrast-enhanced echocardiograms in an ICU setting."

Using the Premier Perspective database, 145,882 adult inpatient records were matched by propensity score for age, race, gender, hospital, and admission type, multiple comorbid conditions, and APR-DRG (All Patient Refined Diagnosis Related Groups) severity of illness. Of these, 39,189 patients were critically ill and in the ICU when the echocardiogram was performed, 19,318 patients received contrast-enhanced studies, approximately 78% of the total population received Definity. A subset of 12,572 patients on mechanical ventilation was also examined. Premier's Perspective database is the largest clinical comparative database in the United States used to track hospital performance in five clinical areas: acute myocardial infarction (AMI); heart failure; community-acquired pneumonia; coronary artery bypass graft (CABG); and hip and knee replacement.

Short-term mortality rates (< 48 hours of echocardiogram) were 2.98% for patients undergoing noncontrast studies and 2.30% for patients undergoing contrast-enhanced examinations. A multivariate logistic regression analysis was used to compare short-term mortality, controlling for case mix and clinical covariates. Critically ill patients undergoing contrast-enhanced echocardiograms had a statistically significant 26% lower risk-adjusted odds ratio for 48-hour mortality than those patients who received only echocardiography without the ultrasound contrast agent. For those patients on mechanical ventilation, 48-hour mortality rates were 6.11% for those undergoing noncontrast exams and 4.59% for individuals with contrast-enhanced examinations, representing a 27% lower mortality rate for the contrast-enhanced group.

"With Definity already widely used in the intensive care unit settings, the results confirm that there is a survival advantage associated with using echocardiogram contrast agents appropriately," said Mark Hibberd, M.D., Ph.D., senior medical director, Global Medical Affairs, Lantheus Medical Imaging, and coauthor on the study. "The contrast-associated survival advantage is important, especially in the mechanically ventilated patients, in whom routine echocardiography without contrast is especially challenging. The current database analysis does not allow us to draw conclusions on the reasons why contrast utilization is associated with a survival advantage. Some possible explanations include more accurate, faster diagnoses leading to better patient management decisions, and/or the avoidance of other potentially higher-risk or invasive tests that become unnecessary after contrast echocardiography. This study follows [another recent study] in which it was demonstrated that echocardiogram image quality was significantly improved in 88% of those studies having suboptimal images without contrast and where the use of Definity significantly changed patient management particularly in ICU/SICU [surgical intensive care] patients. [That] study gives the medical community further clinical evidence of the important role Definity can play in improving the standard of care for patients in the ICU."

Since its launch in 2001, activated Definity has been administered to over two million patients. In patients with suboptimal echocardiograms, Definity enables physicians to visualize the borders of the heart more clearly. In 2008, Lantheus announced the initiation of CaRES (Contrast Echocardiography REgistry for Safety Surveillance), the first multicenter phase IV observational registry that will further evaluate the safety profile of Definity in patients with suboptimal echocardiograms and provide safety information on the use of ultrasound contrast agents in routine clinical practice. The open-label, nonrandomized registry is being conducted in 15 clinical sites in the United States and will include at least 1,000 patients. The study will gather data on patient characteristics and demographics, indication for Definity's use, results of safety monitoring of patients during and after Definity administration, and the nature and frequency of any adverse events that may occur.

Activated Definity is indicated for use in patients with suboptimal echocardiograms to opacify the left ventricular chamber and to improve the delineation of the left ventricular endocardial border. The safety and efficacy of Definity with exercise stress or pharmacologic stress testing have not been established.

Lantheus Medical Imaging discovers, develops, and markets medical imaging agents provides a platform from which to bring forward breakthrough new tools for the diagnosis and management of disease.

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University of Missouri

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52 (!!!!! 1390.9339904785): SELECT name FROM jos_deeppockets WHERE id=294722906 LIMIT 1

53 (!!!!! 1481.0562133789): SELECT name FROM jos_deeppockets_archive WHERE id=294722906 LIMIT 1

54 (638.96179199219): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

55 (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.cat=10 AND dp.id=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (775.09880065918): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 5851.0303497314): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

58 (273.9429473877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

59 (!!!!! 4503.9653778076): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

60 (970.84045410156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

61 (!!!!! 1608.13331604): 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 (!!!!! 1098.1559753418): SELECT fid FROM jos_deeppockets WHERE id=294722906 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722906 AND published='1' LIMIT 1

63 (375.98609924316): 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=214 ORDER BY `ordering`

64 (!!!!! 3734.1117858887): select jos_twitters.link from jos_twitters where cat=10

65 (494.00329589844): select jos_facebook.link from jos_facebook where cat=10

66 (615.83518981934): select jos_google_plus.link from jos_google_plus where cat=10

67 (515.93780517578): select jos_linkedin.link from jos_linkedin where cat=10

68 (179.05235290527): SELECT fid FROM jos_deeppockets WHERE id=294722906 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294722906 AND published='1' LIMIT 1

69 (33.855438232422): 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=214 ORDER BY `ordering`

70 (!!!!! 5981.9221496582): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (519.0372467041): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (413.89465332031): 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 (!!!!! 1887.0830535889): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (631.09397888184): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 1194.953918457): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 3957.986831665): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (756.02531433105): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 1061.9163513184): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (334.02442932129): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (214.0998840332): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (886.20185852051): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (53.167343139648): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (511.16943359375): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (48.87580871582): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1353.0254364014): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (562.19100952148): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (742.91229248047): 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 (802.99377441406): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 7303.9531707764): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3499.9847412109): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (!!!!! 3924.1313934326): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (797.98698425293): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (446.79641723633): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (252.96211242676): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (571.01249694824): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (211.95411682129): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (181.91337585449): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (130.89179992676): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (169.03877258301): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (119.20928955078): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (844.95544433594): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 3715.991973877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

105 (417.94776916504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

106 (77.962875366211): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 8876.0852813721): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3304.9583435059): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

109 (!!!!! 4565.0005340576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

110 (290.87066650391): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 4125.8335113525): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (845.90911865234): 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 (!!!!! 1440.0482177734): 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 (874.99618530273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

115 (313.04359436035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

116 (!!!!! 1181.1256408691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

117 (392.91381835938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

118 (586.03286743164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

119 (770.09201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

120 (874.99618530273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

121 (297.06954956055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

122 (!!!!! 3736.9728088379): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 263298.98834229): 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 (!!!!! 12612.104415894): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722906 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722906 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 41937.828063965): ( 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 (947.95227050781): ( 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 (652.07481384277): 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 (486.85073852539): 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 (681.87713623047): 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 (766.99256896973): 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 (489.95018005371): 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 (87.02278137207): 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 (422.00088500977): 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 (211.95411682129): 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 (!!!!! 2779.9606323242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1451.9691467285): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 2409.9349975586): SELECT name FROM jos_deeppockets WHERE id=214

138 (150.91896057129): SELECT name FROM jos_deeppockets WHERE id=214

139 (!!!!! 1593.8282012939): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (952.00538635254): 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 '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 5538.9404296875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

142 (!!!!! 2289.0567779541): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

143 (!!!!! 34080.982208252): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 6999.9694824219): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (717.8783416748): 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=294722906 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 4745.9602355957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (646.11434936523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (247.95532226562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

149 (313.04359436035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

150 (!!!!! 6046.0567474365): 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 (!!!!! 2263.069152832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

152 (608.92105102539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

153 (!!!!! 3844.0227508545): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294722906 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294722906 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (546.93222045898): 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=214 or channel_id is null)

155 (!!!!! 3722.9061126709): 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=214 or channel_id is null)

156 (!!!!! 1187.0861053467): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 3028.1543731689): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

158 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294722906 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294722906 AND published='1' LIMIT 1

159 (!!!!! 1350.8796691895): select jos_twitters.link from jos_twitters where cat=10

160 (727.17666625977): select jos_facebook.link from jos_facebook where cat=10

161 (265.12145996094): select jos_google_plus.link from jos_google_plus where cat=10

162 (371.93298339844): select jos_linkedin.link from jos_linkedin where cat=10

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