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Ultrasound Elasticity Imaging Differentiates Intestinal Inflammation from Fibrosis

By MedImaging International staff writers
Posted on 14 Nov 2011

It is difficult for clinicians to distinguish whether a patient with Crohn’s disease has intestinal fibrosis, which requires surgery, or inflammation, which can be treated with medicine. More...

A new imaging method could make that task easier.

Ultrasound elasticity imaging (UEI), could allow clinicians to make the distinction between inflammation and fibrosis noninvasively, allowing patients to receive more appropriate and timely care. The study was published in the September 2011 edition of the journal Gastroenterology.

Crohn’s disease patients suffer from chronic inflammation of the intestines, which over time can cause scar tissue to form, resulting in intestinal fibrosis. Patients with intestinal inflammation usually are treated with medicines that suppress their immune system, while patients with fibrosis are treated surgically. Because current diagnostic tests, including computed tomography (CT) and magnetic resonance imaging (MRI) scans, cannot detect the difference between the two conditions, many patients with fibrosis are often initially treated with immune system-suppressing drugs, which are expensive and are unlikely to help.

“These therapies are potent, costly, and carry risk,” said Ryan Stidham, MD, clinical lecturer in the University of Michigan (U-M; Ann Arbor, USA) department of internal medicine. “And for patients with fibrosis, such treatment might be for naught.”

Inflamed intestinal tissue is softer than fibrotic tissue, which is hard and thick. The new method uses ultrasound to measure the relative hardness and thickness of tissue inside the body, potentially allowing clinicians to distinguish between the two conditions without performing surgery. In animal models, UEI was able to visualize accurately the difference between inflamed tissue and scar tissue. “The goal of this study is to have technology that can make the distinction between fibrosis and inflammation,” stated Dr. Stidham, the lead author of the study. “We want to know if it’s worth it to push medical therapy, or if a person is destined for surgery.”

Moreover, the researchers discovered that UEI was capable of differentiating between fibrotic and unaffected intestine in a pilot human study. Patients already scheduled for surgical treatment underwent UEI assessment prior to surgery, and fibrotic strictures were identified in each case.

According to Dr. Stidham, the next step in the group’s research is a long-term human clinical trial, beginning the end of 2011. If UEI is able to evaluate a patient’s condition effectively, physicians will be able to treat Crohn’s disease patients suffering from inflammation or fibrosis more efficiently. “UEI has great potential to provide a clear measurement that helps clinicians judge whether medical or surgical management is best for the individual patient earlier in their disease course,” Dr. Stidham concluded.

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59 (120.16296386719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

60 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

61 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

62 (127.07710266113): 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 (597.00012207031): SELECT fid FROM jos_deeppockets WHERE id=294738003 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738003 AND published='1' LIMIT 1

64 (50.783157348633): 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 (75.817108154297): select jos_twitters.link from jos_twitters where cat=10

66 (32.901763916016): select jos_facebook.link from jos_facebook where cat=10

67 (34.093856811523): select jos_google_plus.link from jos_google_plus where cat=10

68 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

69 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE id=294738003 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738003 AND published='1' LIMIT 1

70 (44.107437133789): 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 (547.88589477539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (402.92739868164): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (61.03515625): 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 (98.943710327148): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (!!!!! 3165.9603118896): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (94.175338745117): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (49.114227294922): 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 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

106 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

107 (97.036361694336): 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=294738003 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (719.07043457031): 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=294738003 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (128.98445129395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

110 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

111 (87.02278137207): 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=294738003 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (710.96420288086): 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=294738003 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (897.88436889648): 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 (545.02487182617): 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 (315.90461730957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

116 (499.96376037598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

117 (590.08598327637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

118 (913.85841369629): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

119 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

120 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

121 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

122 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

123 (349.99847412109): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 78927.040100098): 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 (!!!!! 1477.0030975342): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738003 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738003 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 18081.903457642): ( 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 (52.928924560547): ( 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 (619.88830566406): 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 (47.206878662109): 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 (46.968460083008): 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 (31.948089599609): 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 (371.93298339844): 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 (224.11346435547): 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 (414.13307189941): 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 (43.869018554688): 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 (498.05641174316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 1006.8416595459): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (49.829483032227): SELECT name FROM jos_deeppockets WHERE id=214

139 (29.802322387695): SELECT name FROM jos_deeppockets WHERE id=214

140 (627.04086303711): 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 (783.20503234863): 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 (447.03483581543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

143 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

144 (!!!!! 22830.963134766): TRUNCATE TABLE jos_trademed_module

145 (204.08630371094): 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=294738003 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (90.837478637695): 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=294738003 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (696.89750671387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

150 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

151 (!!!!! 3462.7914428711): 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 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

153 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

154 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738003 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738003 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (52.213668823242): 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 (42.915344238281): 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 (!!!!! 2257.1086883545): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (137.8059387207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

159 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738003 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738003 AND published='1' LIMIT 1

160 (75.101852416992): select jos_twitters.link from jos_twitters where cat=10

161 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

162 (43.869018554688): 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 (342.84591674805): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

165 (!!!!! 1497.0302581787): insert into jos_banners_delta values (14202,'2025-08-12 15:40:31','216.73.216.186','view'),(14203,'2025-08-12 15:40:31','216.73.216.186','view')

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