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Promising Use of Tumor Marker and Targeted Endoscopic Ultrasound for Early Detection of Pancreatic Cancer

By MedImaging International staff writers
Posted on 10 Aug 2011

Researchers reported that using a tumor marker, serum CA [cancer antigen]19-9, combined with an endoscopic ultrasound if the tumor marker is elevated, is more likely to detect stage 1 pancreatic cancer in a high-risk population than by using the standard means of detection.

The study’s findings were published in the July 2011 issue of Gastrointestinal Endoscopy, the scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE).

Pancreatic cancer is the fourth leading cause of cancer death in the United States. Advanced disease at diagnosis correlates directly with worse overall survival. Symptoms of abdominal pain, jaundice, and/or weight loss frequently do not appear until the tumor is locally advanced or metastatic, at which point effective treatment options are very limited. By contrast, detection and resection of pancreatic cancer, when it is confined to the pancreas (stage 1 disease), improves overall survival. An effective screening protocol is urgently needed to detect earlier stage tumors. Imaging methods that have been used for pancreatic cancer screening include endoscopic ultrasound (EUS), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance imaging cholangiopancreatography (MRCP).

There has been limited success in screening younger populations using the tumor marker CA19-9, so more recent pancreatic cancer screening protocols have focused on high-risk populations. It is estimated that 10% of patients in whom pancreatic cancer develops have at least one first-degree relative with the disease. Multiple cohort and case-control studies have demonstrated that a family history of a first-degree relative with pancreatic cancer significantly increases a patient’s risk of the development of pancreatic cancer, approximately two to five-fold. The risk of the development of pancreatic cancer increases significantly as the number of affected family members increases. Advanced age is also a significant risk factor, and 93% of patients with pancreatic cancer present after the age of 50.

“Our hypothesis was that a high-risk population identified by age and at least one first-degree relative with pancreatic cancer can be successfully screened. Our objective was to determine whether early pancreatic neoplasia can be detected in a high-risk population by using tumor marker CA 19-9 followed by targeted endoscopic ultrasound. We also sought to determine whether this protocol was more likely to detect early stage pancreatic cancer than standard means of detection,” said study lead author Richard Zubarik, MD Fletcher Allen Health Care, University of Vermont (Burlington, USA). “Our results showed that potentially curative pancreatic adenocarcinoma can be identified with this screening protocol. Stage 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection.”

This prospective cohort study was conducted at the University of Vermont (UVM) and the Dartmouth-Hitchcock Medical Center (DHMC; Lebanon, NH, USA). Patients were enrolled from September 2006 to July 2009. Patients included were between the ages of 50 and 80 and had at least one first-degree relative (parent, sibling, or child) with pancreatic cancer. Enrollment was initiated at age 45 if a patient had two first-degree relatives with pancreatic cancer and at age 40 if the person had a BRCA2 mutation or Peutz-Jeghers syndrome.

Serum CA 19-9 testing was performed on all patients. It was chosen as the initial screening method because it is acceptable to patients, easily obtainable, widely available, inexpensive, and relatively sensitive for the disease. Endoscopic ultrasound was performed only in patients with an elevated CA 19-9 level (a CA 19-9 value greater than 37 U/mL was considered elevated) regardless of whether only one or more than one family member was affected with pancreatic cancer.

A total of 546 patients were enrolled in the study. CA 19-9 was elevated in 27 patients (4.9%). Neoplastic or malignant findings were detected in five patients (0.9%), and pancreatic cancer in one patient (0.2%). The patient with pancreatic cancer detected as part of this study was one of two patients presenting to the University of Vermont with stage 1 cancer. One-year follow-up contact was performed by telephone in 519 patients (95%), by chart review in 24 patients (4%), and by review of the social security death index in three patients (less than 1%). Pancreatic cancer was not detected at the one-year follow-up in any additional patients.

In the comparison group, a total of 124 patients received a diagnosis of pancreatic cancer between September 2006 and July 2009. Staging of the comparison group at the time of presentation was as follows: stage 1, one patient (0.9%); stage 2, 52 patients (45.6%); stage 3, 20 patients (17.5%); stage 4, 41 patients (36%). The patient detected in the CA 19-9/EUS study had stage 1 disease, whereas only 0.9% of patients in the comparison group presented with stage 1 disease. This difference was statistically significant despite only having one patient with pancreatic cancer detected in the study group because the detection of stage 1 cancer in the comparison group was so rare. Median survival for the 122 subjects in the comparison group was seven months, with a two-year survival rate of 10%.

The results conclude that potentially curative pancreatic cancer can be identified with CA 19-9 and targeted EUS. Stage 1 pancreatic cancer is more likely to be detected by using this screening protocol than by using standard means of detection. Potential advantages include acceptable rates of disease diagnosis and exclusion as well as acceptable costs (cost to detect one pancreatic neoplasia was US$8,431, while the cost to detect 1 pancreatic cancer was $41,133). In particular, the patient with pancreatic cancer detected with this screening protocol is alive without evidence of recurrence three years after surgical resection and is the longest survivor of pancreatic cancer detected in a published screening protocol. Moreover, evidence of pancreatic cancer did not develop in subjects with negative screening studies, at least in short-term follow-up.

The researchers note that the sample size is adequate only to demonstrate the feasibility of this approach, but summarized that this trial successfully screened a high-risk patient population for pancreatic cancer based on age and genetic predisposition. Early pancreatic cancer, associated with prolonged disease-free survival, can be detected as part of this pancreatic screening protocol. Stage 1 pancreatic cancer was more likely to be detected with CA 19-9 and targeted EUS, and it appears to be better than the conventional means of pancreatic cancer detection.

Related Links:
University of Vermont
Dartmouth-Hitchcock Medical Center

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51 (81.777572631836): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

52 (!!!!! 3357.8872680664): SELECT name FROM jos_deeppockets WHERE id=294736534 LIMIT 1

53 (339.03121948242): SELECT name FROM jos_deeppockets_archive WHERE id=294736534 LIMIT 1

54 (47.922134399414): 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 (61.03515625): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

56 (450.13427734375): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 2780.9143066406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

58 (411.03363037109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

59 (!!!!! 3425.8365631104): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

60 (!!!!! 3841.8769836426): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

61 (!!!!! 8590.9366607666): 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 (!!!!! 6075.8590698242): SELECT fid FROM jos_deeppockets WHERE id=294736534 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736534 AND published='1' LIMIT 1

63 (630.14030456543): 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 (440.12069702148): select jos_twitters.link from jos_twitters where cat=10

65 (83.208084106445): select jos_facebook.link from jos_facebook where cat=10

66 (63.896179199219): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

68 (60.796737670898): SELECT fid FROM jos_deeppockets WHERE id=294736534 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736534 AND published='1' LIMIT 1

69 (92.983245849609): 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 (980.85403442383): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (511.88468933105): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (59.127807617188): 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 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.186508178711): 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 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

105 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

106 (71.048736572266): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (52.928924560547): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3126.859664917): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

109 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

110 (133.03756713867): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (698.08959960938): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (931.0245513916): 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 (491.85752868652): 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 (589.84756469727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

115 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

116 (332.11708068848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

117 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

118 (!!!!! 2138.8530731201): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

119 (925.06408691406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

120 (697.85118103027): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

121 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

122 (267.02880859375): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 50110.101699829): 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 (594.8543548584): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736534 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736534 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (325.91819763184): ( 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 (56.982040405273): ( 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 (166.89300537109): 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 (36.001205444336): 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 (904.79850769043): 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 (68.902969360352): 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 (51.975250244141): 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 (45.061111450195): 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 (45.061111450195): 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 (32.901763916016): 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 (!!!!! 4354.0000915527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (512.12310791016): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (45.7763671875): SELECT name FROM jos_deeppockets WHERE id=214

138 (32.186508178711): SELECT name FROM jos_deeppockets WHERE id=214

139 (645.87593078613): 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 (495.91064453125): 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 (116.10984802246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

142 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

143 (!!!!! 12709.856033325): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 3125.9059906006): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (128.03077697754): 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=294736534 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (516.17622375488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

149 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

150 (!!!!! 1486.06300354): 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 (964.87998962402): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

152 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

153 (96.797943115234): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736534 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736534 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (43.869018554688): 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 (41.007995605469): 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 (61.988830566406): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

158 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736534 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736534 AND published='1' LIMIT 1

159 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

160 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

161 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

163 (324.01084899902): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

164 (!!!!! 1369.9531555176): insert into jos_banners_delta values (14202,'2025-08-12 18:33:34','216.73.216.186','view'),(14203,'2025-08-12 18:33:34','216.73.216.186','view')

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