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Ultrasound Found to Predict Tumor Burden, Survival in Melanoma Patients

By MedImaging International staff writers
Posted on 12 Oct 2009

Researchers have shown for the first time that patterns of ultrasound signals can be utilized to identify whether or not cancer has started to metastasized in melanoma patients, and to what extent. The discovery enables clinicians to decide on how much surgery, if any, is required and to predict the patient's probable survival.

Dr. Christiane Voit, from Charité-Universitätsmedizin Berlin, the Medical University of Berlin (Germany), told Europe's largest cancer congress, ECCO 15-- ESMO 34, in Berlin, Germany, on September 23, 2009, "We have identified two ultrasound patterns of lymph node metastasis in melanoma patients which can identify correctly any amount of tumor cells in the sentinel lymph nodes in 75-90% of cases before proceeding to surgery on the sentinel lymph nodes.”

Dr. Voit, who is a dermatologist and head of the diagnostic unit at the Skin Cancer Center at Charité-Universitätsmedizin Berlin, reported that although her research needs to be confirmed in multicenter, randomized clinical trials, it had the potential to spare patients unnecessary surgery, particularly if it was combined with ultrasound-guided fine needle biopsy of lymph nodes rather than conventional surgery.

Since 2001, Dr. Voit and her colleagues in Germany and The Netherlands have included 850 melanoma patients in a prospective study to investigate the use of ultrasound in diagnosis and treatment planning. They have already demonstrated that ultrasound-guided fine needle biopsy of sentinel nodes before conventional sentinel node surgery can identify up to 65% of patients in whom the cancer has started to spread. This study showed how far ultrasound patterns correlate with disease progression, tumor burden, survival, and prognosis in the first 400 of these patients with stage I/II melanoma and with the longest follow-up.

Before having sentinel node surgery, the patients were investigated using ultrasound, and these results were checked against the results of the subsequent surgery. The researchers found that two ultrasound patterns together could accurately identify the amount of cancer cells in the lymph nodes in 80% of cases.

A balloon-shape ultrasound pattern with or without loss of central echoes (where the lymph node has lost central echoes or still has some residual central echoes, but these are traveling toward the rim, giving an asymmetrical shape to the center) was an indicator in up to 83% of cases of a large amount of cancer cells in the sentinel node. "This ultrasound pattern was a late sign, only occurring in cases of advanced metastasis,” said Dr. Voit.

A pattern of peripheral perfusion (where small blood vessels start to surround the lymph node) was an early sign of a small number of cancer cells present. "The early signs are signs of first disruption of the normal lymph node architecture by an early stage metastasis. The most important one is peripheral perfusion, which shows angiogenesis [the formation of new blood vessels] is occurring,” she explained.

The researchers found that these two ultrasound patterns could predict overall survival. Estimates for overall survival after five years for patients with stage I/II is between 50-90% depending on the state of the tumor. Dr. Voit discovered that 93% of patients with neither of these ultrasound patterns, 87% of patients with peripheral perfusion, and 56% of patients with balloon shapes with or without loss of central echoes, survived for at least five years; survival without cancer spreading to other parts of the body was 74%, 60%, and 26%, respectively.

Dr. Voit said, "for the first time we have established that ultrasound patterns can be used as criteria for diagnosing disease progression and tumor burden. Balloon-shaped lymph nodes with or without loss of central echoes and peripheral perfusion are independent prognostic factors for survival.”

Discovering if cancer has spread to the lymph nodes is the most important factor influencing the prognosis and treatment of melanoma patients. Physicians typically excise one or two key lymph nodes, called sentinel nodes, and use these as an indicator of whether or not the cancer has spread to the other lymph nodes. If the sentinel node is free of cancer, patients do not need to have more extensive lymph node removal.

However, only 20% of patients who have a sentinel node biopsy have cancer that has metastasized there, and therefore the procedure, which can be accompanied by side effects such as chronic swelling and seroma, is unnecessary for 80% of patients. Using ultrasound first to detect the presence or not of sentinel node metastases could be a noninvasive way of limiting the numbers of patients who require subsequent surgery or simply watchful follow-up care, according to the investigators.

ECCO 15--ESMO 34 is the 15th congress of the European Cancer Organization and the 34th Congress of the European Society for Medical Oncology.

Related Links:
Charité-Universitätsmedizin Berlin, the Medical University of Berlin

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54 (!!!!! 1110.0769042969): 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 (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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (!!!!! 1831.0546875): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1821.9947814941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

58 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

59 (208.13941955566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

60 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

61 (!!!!! 7355.9284210205): 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 (827.07405090332): SELECT fid FROM jos_deeppockets WHERE id=294725934 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294725934 AND published='1' LIMIT 1

63 (82.969665527344): 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 (108.95729064941): select jos_twitters.link from jos_twitters where cat=10

65 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

66 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

67 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

68 (81.062316894531): SELECT fid FROM jos_deeppockets WHERE id=294725934 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294725934 AND published='1' LIMIT 1

69 (47.922134399414): 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 (!!!!! 5550.8613586426): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (557.18421936035): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (54.836273193359): 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 (87.02278137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (63.180923461914): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 4528.0456542969): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (115.87142944336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 3361.9403839111): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (101.80473327637): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (42.915344238281): 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 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 2605.9150695801): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (!!!!! 3822.8034973145): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (97.990036010742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

105 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

106 (56.982040405273): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (581.97975158691): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2830.0285339355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

109 (!!!!! 3954.8873901367): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

110 (159.97886657715): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (726.93824768066): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 2783.0600738525): 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 (674.96299743652): 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 (!!!!! 2363.920211792): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

115 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

116 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

117 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

118 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

119 (42.200088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

120 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

121 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

122 (267.98248291016): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 44222.116470337): 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 (!!!!! 7328.987121582): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725934 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725934 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 18825.054168701): ( 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 (!!!!! 3087.043762207): ( 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 (184.05914306641): 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 (92.029571533203): 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 (424.14665222168): 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 (221.01402282715): 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 (349.04479980469): 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 (41.007995605469): 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 (237.94174194336): 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 (113.01040649414): 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 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 2967.8344726562): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (575.06561279297): SELECT name FROM jos_deeppockets WHERE id=214

138 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=214

139 (678.77769470215): 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 (711.91787719727): 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 (682.83081054688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

142 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

143 (!!!!! 29148.101806641): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 6430.1490783691): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 7925.0335693359): 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=294725934 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 2188.9209747314): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (360.01205444336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2092.1230316162): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

149 (135.89859008789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

150 (!!!!! 3461.1225128174): 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 (!!!!! 1352.071762085): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

152 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

153 (!!!!! 4678.9646148682): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294725934 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294725934 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 2609.9681854248): 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 (120.87821960449): 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 (345.94535827637): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (690.93704223633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

158 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294725934 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294725934 AND published='1' LIMIT 1

159 (!!!!! 7711.8873596191): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 7071.0182189941): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 5398.0350494385): select jos_google_plus.link from jos_google_plus where cat=10

162 (!!!!! 1068.115234375): select jos_linkedin.link from jos_linkedin where cat=10

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