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Ultrasound, Fluid Dynamics Used for Predicting Plaque in Coronary Arteries

By MedImaging International staff writers
Posted on 22 Aug 2011

Researchers have developed a method for predicting which areas of the coronary arteries will develop more atherosclerotic plaque over time, based on intracoronary ultrasound and blood flow measurements. More...

The method could help physicians identify “vulnerable plaque,” which unstable plaque that is likely to cause a heart attack or stroke. It involves calculating shear stress, or how hard the blood pulls on the walls of the arteries, based on the geometry of the arteries and how fast the blood is moving.

Researchers from Emory University (Atlanta, GA, USA) and Georgia Institute of Technology (Georgia Tech; Atlanta, USA) posted their findings online August 2011 in the journal Circulation. The lead author is Habib Samady, MD, professor of medicine and director of interventional cardiology at Emory University School of Medicine. Most people who have heart attacks do not have plaques in their arteries that bulge out and obstruct blood flow beforehand. Instead, the plaques in their arteries crack and spill open, leading to a clot. Dr. Samady reported that his team’s ultimate aim is to try to figure out where that will happen.

Cardiology researchers examining arteries in isolation or in animals have long seen a link between branches in the arteries, disturbances in blood flow, and where atherosclerosis develops. The challenge was to translate observations from the laboratory to imaging the heart within a live person, according to Dr. Samady. “It’s like looking at a river and predicting where sediment will accumulate,” he said. “It sounds obvious, but it’s hard to do it for every nook and cranny in the coronary arteries.”

The Emory/Georgia Tech study was the largest published investigation of shear stress and plaque progression in humans so far, and the first to examine people with significant coronary artery disease. Doctors examined 20 patients in Emory University Hospital’s catheterization laboratory between December 2007 and January 2009. They were being examined because they had abnormal exercise electrocardiograms (ECGs) or stable chest pain. The patients' coronary arteries were examined by intracoronary ultrasound and Doppler guide wire before and after six months of therapy with atorvastatin (Lipitor).

To model shear stress, Dr. Samady, assistant professor Michael McDaniel, MD, and postdoctoral fellow Parham Eshtehardi, MD, teamed up with Drs. Jin Suo and Don Giddens, experts in fluid mechanics at Georgia Tech. The patients’ arteries were divided into more than 100 segments each, and the shear stress was calculated for each one. Ultrasound allowed the researchers to estimate the size and composition of the plaques in each segment before and after the six-month period.

“Some atherosclerotic plaque appears to develop in a steady progression, and in other places, it develops in fits and spurts. These areas exist within the same patient and the same artery,” Dr. Samady stated. “Our thinking is that the places where plaque develops in more fits and spurts may lead to the rupture of plaque, leading to a clot that blocks blood flow. In contrast, the places where you have steady progression may be more stable, as long as there is a fibrous covering that is thick enough.”

Analyzing each segment, the overall area of the plaque increased and the core of the plaque grew larger in places where shear stress was particularly low. In places where the shear stress was high, there was shrinking of the fibrous covering of the plaque and expansion of lipid necrotic core and dense calcified areas. “High shear stress leads to regression, which you might think is good, but there are some bad actors that may lead to plaque rupture,” Dr. Samady said. “What’s new here is that we're seeing the detrimental effects of both low and high shear stress.”

The data also revealed that arterial plaques could grow despite anti-cholesterol therapy with statins, the current standard of care. To really assess whether plaque in a certain spot is going to be dangerous, Dr. Samady noted that physicians would need to look at outcomes in more patients over a longer period. “The dream is to predict which spot is vulnerable, and use that to guide treatment with drugs and interventions like stents,” he said.

For the present, the shear stress-based technique can be used to monitor patients’ progress and determine how well treatment is working. According to Dr. Samady, ultrasound and blood flow measurements could be combined with a newer method called optical coherence tomography for better resolution and more information.

Related Links:
Emory University
Georgia Institute of Technology

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56 (65.088272094727): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (493.04962158203): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1348.9723205566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

59 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

60 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

61 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

62 (82.969665527344): 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

63 (504.0168762207): SELECT fid FROM jos_deeppockets WHERE id=294736694 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736694 AND published='1' LIMIT 1

64 (49.829483032227): 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`

65 (60.081481933594): select jos_twitters.link from jos_twitters where cat=10

66 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

67 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

68 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

69 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294736694 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294736694 AND published='1' LIMIT 1

70 (92.029571533203): 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`

71 (384.09233093262): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (298.02322387695): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (40.054321289062): 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`

74 (89.883804321289): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): 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 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (46.014785766602): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (31.948089599609): 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`

91 (55.789947509766): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (31.232833862305): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

106 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

107 (51.021575927734): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (55.074691772461): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

110 (159.97886657715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

111 (51.021575927734): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (580.78765869141): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (635.14709472656): 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 (380.9928894043): 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

115 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

116 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

117 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

118 (132.08389282227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

119 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

120 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

121 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

122 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

123 (342.84591674805): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 21785.020828247): 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

125 (536.91864013672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736694 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736694 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 7768.1541442871): ( 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 (81.062316894531): ( 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

128 (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

129 (30.994415283203): 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

130 (40.054321289062): 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 (29.087066650391): 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

132 (328.06396484375): 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 (56.028366088867): 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

134 (51.975250244141): 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 (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

136 (539.06440734863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (410.07995605469): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (52.928924560547): SELECT name FROM jos_deeppockets WHERE id=214

139 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=214

140 (624.8950958252): 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 (468.01567077637): 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

142 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

143 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

144 (!!!!! 9421.1101531982): TRUNCATE TABLE jos_trademed_module

145 (108.00361633301): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (61.988830566406): 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=294736694 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (788.92707824707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

150 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

151 (!!!!! 1193.0465698242): 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

152 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

153 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

154 (39.100646972656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294736694 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294736694 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (35.04753112793): 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 (32.901763916016): 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)

157 (78.916549682617): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (134.22966003418): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

159 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294736694 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294736694 AND published='1' LIMIT 1

160 (55.074691772461): select jos_twitters.link from jos_twitters where cat=10

161 (34.093856811523): select jos_facebook.link from jos_facebook where cat=10

162 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

163 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

164 (291.82434082031): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

165 (!!!!! 1281.0230255127): insert into jos_banners_delta values (14202,'2025-08-12 18:33:44','216.73.216.186','view'),(14203,'2025-08-12 18:33:44','216.73.216.186','view')

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