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Ultrasound Enhances Noninvasive Down Syndrome Tests

By MedImaging International staff writers
Posted on 21 Dec 2009

The addition of a "genetic sonogram” maximizes the accuracy of noninvasive testing for Down syndrome.

"We wanted to be able to definitively describe the detection and accuracy of noninvasive prenatal screening for the detection of Down syndrome,” said Dr. Kjersti Aagaard, assistant professor of obstetrics and gynecology at Baylor College of Medicine (BCM; Houston, TX, USA) and the lead author of the landmark study, published in the November 2009 issue of the journal Obstetrics and Gynecology. "Using our data generated in the most comprehensive study performed to date (FaSTER [for First and Second Trimester Evaluation of Risk] trial), we demonstrated that the addition of a genetic sonogram to all modes of screening in pregnancy allows for optimal noninvasive prenatal detection of Down syndrome.”

Noninvasive screening for Down syndrome (as well as the other major fetal genetic or chromosomal abnormalities in the developing infant) involves a specific early ultrasound and series of tests for biochemical components in the mother's blood at specific times during pregnancy. Depending on the institution and clinic, tests are performed during the first and/or second trimesters of pregnancy. Optimally, noninvasive screening also includes that a preliminary ultrasound to detect nuchal translucency takes place late in the first trimester. The test measures the clear or translucent space in the tissue at the back of the fetus' neck. If there is an abnormality, fluid will accumulate in the back of the neck, making the nuchal fold area larger.

In the first trimester, measured maternal serum markers include pregnancy-associated plasma protein A (PAPP-A) and free beta human chorionic gonadotropin (beta hCG). In the second trimester, physicians measure alpha-fetoprotein, beta hCG, unconjugated estriol and inhibin A. The tests ordered and the combinations vary among institutions and clinics. Often, these tests are utilized as a basis for counseling women on the option of the more invasive but definitive tests such as amniocentesis, which involves directly measuring the chromosomal material in fetal cells found in the fluid inside the uterus, and chorionic villus sampling, an earlier means of obtaining fetal cells from tissue found in the placenta. Each is the definitive means of testing for genetic or chromosomal disorders that affect the fetus.

However, each of these invasive tests carries risk for potential complications, and many pregnant women seek to avoid those risks if at all possible. Because of this, researchers have spent several decades optimizing noninvasive prenatal diagnostic screening. One key component of this screening program has come to include the genetic sonogram. A genetic sonogram is simply an advanced ultrasound that details the fetal anatomy in the second trimester, looking for the presence of major fetal anomalies or specific anatomic features (so-called "soft markers") that might be found in a child with Down syndrome, according to Dr. Aagaard.

"Because we build off of the FaSTER trial, our reported adjusted risk measures we describe in this manuscript serve as definitive evidence that the sonogram improves the sensitivity of detection [making it less likely that a Down syndrome diagnosis would be missed] and also decreases the false positive rate,” said Dr. Aagaard. "Combining this with first or first and second trimester screening for biochemical markers gives us the maximal capacity to detect Down syndrome in a noninvasive fashion.”

Dr. Aagaard and her colleagues screened over 8,000 of the nearly 39,000 pregnant women who took part in the FaSTER trial of screening for chromosomal abnormalities (aneuploidy). The detection rate of Down syndrome babies varied from 69% for the genetic sonogram alone to as high as 98% with certain combinations of the biochemical markers. More importantly, the improved detection rate was accompanied by a decrease in the screening tests false-positive rates (or falsely reported risk of Down syndrome in a normal pregnancy).

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59 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

60 (79.870223999023): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

61 (708.10317993164): 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 (472.06878662109): SELECT fid FROM jos_deeppockets WHERE id=294726997 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726997 AND published='1' LIMIT 1

63 (!!!!! 13787.984848022): 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 (996.82807922363): select jos_twitters.link from jos_twitters where cat=10

65 (799.89433288574): select jos_facebook.link from jos_facebook where cat=10

66 (42.915344238281): select jos_google_plus.link from jos_google_plus where cat=10

67 (38.14697265625): select jos_linkedin.link from jos_linkedin where cat=10

68 (43.153762817383): SELECT fid FROM jos_deeppockets WHERE id=294726997 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726997 AND published='1' LIMIT 1

69 (40.054321289062): 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 (781.05926513672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 2129.077911377): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 6101.131439209): 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 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 4364.9673461914): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (303.03001403809): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (923.15673828125): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (318.05038452148): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (195.02639770508): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (130.89179992676): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (81.062316894531): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (96.08268737793): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (907.89794921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (!!!!! 4312.9920959473): 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 (813.96102905273): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 2609.0145111084): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3895.0443267822): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (344.99168395996): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (709.05685424805): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (142.09747314453): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (627.99453735352): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (628.94821166992): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 1303.9112091064): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (776.05247497559): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 7058.1436157227): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (551.93901062012): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 7888.7939453125): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (156.16416931152): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (120.16296386719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

105 (272.98927307129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

106 (137.0906829834): 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=294726997 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (715.01731872559): 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=294726997 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (738.85917663574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

109 (!!!!! 2808.0940246582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

110 (186.92016601562): 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=294726997 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 1626.0147094727): 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=294726997 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (796.07963562012): 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 (535.01129150391): 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 (171.18453979492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

115 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

116 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

117 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

118 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

119 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

120 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

121 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

122 (339.98489379883): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 120617.86651611): 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 (!!!!! 3885.9844207764): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726997 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726997 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (83.92333984375): ( 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 (50.067901611328): ( 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 (56.028366088867): 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 (41.961669921875): 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 (56.982040405273): 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 (41.961669921875): 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 (41.961669921875): 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 (39.815902709961): 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 (41.007995605469): 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 (54.836273193359): 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 (838.04130554199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (633.00132751465): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 4750.9670257568): SELECT name FROM jos_deeppockets WHERE id=214

138 (442.9817199707): SELECT name FROM jos_deeppockets WHERE id=214

139 (900.0301361084): 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 (!!!!! 1013.0405426025): 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 (411.9873046875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

142 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

143 (!!!!! 21831.035614014): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1636.9819641113): 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=294726997 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (315.90461730957): 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=294726997 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 1307.9643249512): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (211.95411682129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2219.9153900146): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

149 (282.04917907715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

150 (!!!!! 3427.9823303223): 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 (!!!!! 1152.9922485352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

152 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

153 (102.04315185547): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726997 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726997 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (45.061111450195): 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 (37.908554077148): 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 (64.849853515625): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 2608.060836792): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

158 (647.06802368164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726997 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726997 AND published='1' LIMIT 1

159 (856.16111755371): select jos_twitters.link from jos_twitters where cat=10

160 (48.160552978516): select jos_facebook.link from jos_facebook where cat=10

161 (39.100646972656): select jos_google_plus.link from jos_google_plus where cat=10

162 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

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