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Women with Silicone Breast Implants May Not Require Follow-Up MRI Scans

By MedImaging International staff writers
Posted on 12 Apr 2011

A recent review questions the diagnostic value of screening magnetic resonance imaging (MRI) scans in women with silicone implants.

The US Food and Drug Administration (FDA) currently recommends regular follow-up MRI scans for women with silicone breast implants. But a new review revealed significant flaws in the evidence supporting this recommendation, according to new findings.

The study's results were reported the March 2011 issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS). Because of these scientific limitations, the available data may overestimate the ability of MRI to detect ruptured breast implants--particularly when scans are performed for screening reasons in symptom-free women. The study was led by Dr. Jae W. Song of the University of Michigan (Ann Arbor, USA).

The researchers reviewed 21 studies evaluating MRI and/or ultrasound to identify rupture of silicone breast implants. Although the FDA recommends MRI scanning, some physicians prefer ultrasound for screening purposes. The combined data suggested that MRI was fairly accurate in detecting implant-related problems. However, it was much more likely to detect problems in women with implant-related symptoms: 14 times more likely than in women without symptoms. Even in a mixed "screening sample”--consisting of some women with and some without symptoms--the detection rate was twice as high as in asymptomatic women.

Because most of the women studied had symptoms, the true accuracy of MRI for detecting implant-related problems in asymptomatic women was probably much lower. For ultrasound, reported accuracy rates varied widely.

Silicone breasts implants have been extensively evaluated because to concerns about possible adverse health effects. Based on reports tying ruptured implants to autoimmune diseases, the FDA banned silicone implants in 1992. The ban was lifted in 2006, when repeated studies could not validate the association with autoimmune diseases. However, the FDA recommended that women undergo regular MRI scans in the years after surgery to screen for implant rupture. Given that more than 1.25 million women in the United States have received silicone implants, it is important to evaluate the evidence that MRI is an effective screening test.

The study raises important questions about the accuracy of MRI scanning, particularly in women without symptoms. Beyond the issue of accuracy, the investigators noted that screening tests are typically performed to detect diseases with serious consequences--whereas the health risks associated with ruptured silicone implants, if any, are still unknown.

The researchers also noted that in reported cases of implant rupture, the average age of the implants is over 10 years. Dr. Song and coauthors wrote in their article, "[T]he benefits of screening within the first 10 years are unclear, and the effectiveness of such a screening program warrants further investigation.”

More studies are also needed, according to the researchers, to evaluate the long-term health effects of ruptured silicone breast implants, the effectiveness of MRI or other screening tests, and the costs of and patient preferences for screening.

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60 (514.98413085938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

61 (!!!!! 8835.0772857666): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

62 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

63 (!!!!! 2267.1222686768): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (!!!!! 5632.1620941162): SELECT fid FROM jos_deeppockets WHERE id=294734482 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734482 AND published='1' LIMIT 1

65 (!!!!! 5069.9710845947): 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`

66 (!!!!! 5383.0146789551): select jos_twitters.link from jos_twitters where cat=10

67 (77.009201049805): select jos_facebook.link from jos_facebook where cat=10

68 (45.061111450195): select jos_google_plus.link from jos_google_plus where cat=10

69 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

70 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE id=294734482 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734482 AND published='1' LIMIT 1

71 (54.121017456055): 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`

72 (440.12069702148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (397.92060852051): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (62.942504882812): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (!!!!! 5360.1264953613): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (148.05793762207): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (175.95291137695): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (176.90658569336): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (312.08992004395): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 3669.9771881104): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (563.8599395752): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (!!!!! 2702.9514312744): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (720.02410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (638.96179199219): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (212.9077911377): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (!!!!! 2032.0415496826): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (540.97175598145): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (!!!!! 1096.9638824463): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (132.08389282227): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (371.93298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (110.86463928223): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (197.8874206543): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (461.81678771973): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1301.0501861572): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 3064.1555786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

107 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

108 (!!!!! 2908.9450836182): 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=294734482 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (591.03965759277): 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=294734482 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (!!!!! 4956.9606781006): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

111 (593.90068054199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

112 (787.97340393066): 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=294734482 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 1973.1521606445): 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=294734482 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (730.99136352539): 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=294734480 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (!!!!! 4756.9274902344): 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=294734480 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (910.04371643066): 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

117 (!!!!! 2529.1442871094): 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

118 (761.03210449219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

119 (236.98806762695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

120 (!!!!! 2254.0092468262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

121 (142.81272888184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

122 (!!!!! 1713.0374908447): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

123 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

124 (486.13548278809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

125 (!!!!! 3022.1939086914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

126 (485.89706420898): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

127 (!!!!! 57611.94229126): 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

128 (!!!!! 1069.7841644287): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734482 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734482 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 19457.101821899): ( 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

130 (97.036361694336): ( 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

131 (123.02398681641): 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

132 (43.869018554688): 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

133 (53.882598876953): 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

134 (34.093856811523): 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

135 (360.96572875977): 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

136 (46.968460083008): 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

137 (65.088272094727): 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

138 (75.101852416992): 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

139 (534.0576171875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

140 (406.98051452637): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

141 (46.968460083008): SELECT name FROM jos_deeppockets WHERE id=214

142 (36.001205444336): SELECT name FROM jos_deeppockets WHERE id=214

143 (!!!!! 1119.1368103027): 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

144 (613.92784118652): 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

145 (!!!!! 1137.9718780518): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

146 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

147 (!!!!! 21289.110183716): TRUNCATE TABLE jos_trademed_module

148 (!!!!! 3460.8840942383): 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=294734482 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

149 (830.17349243164): 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=294734482 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

150 (!!!!! 2923.9654541016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

151 (157.11784362793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

152 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

153 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

154 (!!!!! 2635.9558105469): 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

155 (!!!!! 1524.9252319336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

156 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

157 (651.12113952637): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734482 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734482 AND type='deeppockets_item' AND published='1' LIMIT 1

158 (57.220458984375): 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=0 or channel_id is null)

159 (44.822692871094): 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=0 or channel_id is null)

160 (56.982040405273): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

161 (576.01928710938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

162 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734482 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734482 AND published='1' LIMIT 1

163 (!!!!! 1177.7877807617): select jos_twitters.link from jos_twitters where cat=10

164 (66.041946411133): select jos_facebook.link from jos_facebook where cat=10

165 (43.869018554688): select jos_google_plus.link from jos_google_plus where cat=10

166 (51.975250244141): select jos_linkedin.link from jos_linkedin where cat=10

167 (391.00646972656): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

168 (!!!!! 1633.882522583): insert into jos_banners_delta values (14202,'2025-08-12 18:36:01','216.73.216.186','view'),(14203,'2025-08-12 18:36:01','216.73.216.186','view')

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