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Endoscopic Ultrasound Detects Pancreatic Lesions Common in People at High Risk for Hereditary Pancreatic Cancer

By MedImaging International staff writers
Posted on 25 Apr 2012

A team of scientists has discovered that more than four in 10 people thought to be at high risk for hereditary pancreatic cancer have small pancreatic lesions long before they have any symptoms of the deadly disease. Moreover, the frequency of the abnormal precancerous lesions increases with age and that ultrasound via endoscopy is better than magnetic resonance imaging (MRI) and considerably better than computed tomography (CT) scans at detecting the lesions.

The researchers reported that their research indicates some progress in reducing the death rate from hereditary pancreatic cancer, which is mostly fatal once the lesions become malignant and symptoms occur. At that point, just 25% of those eligible for surgery survive five years, while the rest have a less than 5% chance of surviving five years. The general population has a 0.5% lifetime risk of getting pancreatic cancer, while those in high-risk groups included in the study have risks that are 3.5 to 132 times higher. Researchers reported that about 10%-15% of all pancreatic cancers are hereditary.

“We now know that although these high-risk patients often tend to develop pancreatic lesions, we can detect the lesions, track them over time, and remove them before they become cancer,” says Marcia Irene Canto, MD, MHS, a professor of gastroenterology and oncology at the Johns Hopkins University School of Medicine (Baltimore, MD, USA).

Dr. Canto and her team--comprised of researchers from Johns Hopkins, Mayo Clinic (Rochester, MN, USA), Dana Farber Cancer Institute (Boston, MA, USA), MD Anderson Cancer Center (Houston, TX, USA), and the University of California, Los Angeles (UCLA; USA)--assessed 216 asymptomatic adults with a strong family history of pancreatic cancer, primarily those with two close blood relatives who have had the disease and those who have inherited genetic markers known to increase the risk of pancreatic cancer, including BRCA2 gene mutation that has also been linked to breast and ovarian cancers.

Clinicians at each medical center performed three types of screening on each participant using CT, MRI, and ultrasound conducted via endoscopy. Johns Hopkins screened more than half of the participants. Those interpreting the diagnostic images from any one test were kept unaware of the results of the others to reduce the chance of bias.

CT detected pancreatic abnormalities in 11% of the study participants, MRI found them in 33.3% and endoscopic ultrasound 42.6%. Five participants had what doctors determined were precancerous lesions and underwent surgery to remove them. These were lesions that would most likely not have been detected and removed, according to Dr. Canto.

Dr. Canto’s team discovered that the prevalence of pancreatic lesions increases with age, with doctors finding them in just 14% of high-risk subjects under the age of 50, 34% of those ages 50 to 59, and 53% of those 60- to 69-years old. Those with lesions who did not require surgery were recommended for regular follow-up screening to see if the lesions change in size or shape. Not all pancreatic cysts or lesions become pancreatic cancer.

The findings of the study, known formally as CAPS 3 Study, are published in April 2012 issue of the journal Gastroenterology. One advantage that endoscopic ultrasound has over MRI and CT, according to Dr. Canto, is that it can also be used to collect cells from the pancreatic lesions, secretions from the pancreas, and fluid from cysts to facilitate further study. The CAPS 3 study team collected pancreatic juice for biomarker research led by Michael Goggins, MD, aimed at better detection of pre-cancerous or cancerous lesions in the pancreas. Moreover, a Johns Hopkins research team led by Bert Vogelstein, MD, and Ralph Hruban, MD, are developing biomarkers from pancreatic cyst fluid that appear to determine the cyst’s malignant potential. Recently, they completed genomic sequences of pancreatic cysts that will help biologists determine how they develop and turn cancerous. Researchers hope those findings will enable them to find potentially deadly pancreatic tumors before they develop, saving people from a disease that has little chance for a cure.

For the endoscopic procedure, a clinician passes a thin, lighted tube from a sedated patient’s mouth through the stomach, and into the first part of the small intestine. At the tip of the endoscope is a device that utilizes sound waves that generate patterns of echoes as they bounce off internal organs. These ultrasonic patterns can help identify tumors that cannot be detected by a CT scan. Using ultrasound to help guide the way, a physician then inserts a thin needle into the pancreas to remove cells that can be later studied.

Unlike screening for colon cancer, pancreatic cancer screening is not recommended for the general population. Dr. Canto noted that this is because cysts and other possibly pre-cancerous lesions are far less typical in the pancreas than in the colon; because the pancreas is more difficult to reach than the colon; and because removing lesions requires extensive surgery, frequently including part of the pancreas. Potential complications are also more likely.

“Early detection is the way to go,” Dr. Canto concluded. “We need smart screening and individualized treatments based on family history, epidemiology, biomarkers, and genetics.”

Related Links:
Johns Hopkins University School of Medicine
Dana Farber Cancer Institute
University of California, Los Angeles

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56 (739.09759521484): 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=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1107.931137085): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

58 (!!!!! 5619.0490722656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

59 (!!!!! 1099.1096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

60 (!!!!! 2133.846282959): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

61 (!!!!! 1365.1847839355): 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 (442.9817199707): SELECT fid FROM jos_deeppockets WHERE id=294740344 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740344 AND published='1' LIMIT 1

63 (273.9429473877): 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 (112.05673217773): select jos_twitters.link from jos_twitters where cat=10

65 (29.087066650391): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

68 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294740344 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294740344 AND published='1' LIMIT 1

69 (30.040740966797): 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 (189.78118896484): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (164.03198242188): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 1086.950302124): 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 (611.0668182373): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (752.21061706543): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (314.95094299316): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 1507.9975128174): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (618.93463134766): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 1412.8684997559): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (821.11358642578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1074.0756988525): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 4193.0675506592): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (337.83912658691): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (533.8191986084): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (370.97930908203): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (402.92739868164): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (56.028366088867): 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 (!!!!! 2089.0235900879): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (174.99923706055): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 1528.9783477783): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (130.89179992676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

105 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

106 (!!!!! 1186.8476867676): 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=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (726.93824768066): 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=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2892.017364502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

109 (494.95697021484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

110 (388.86070251465): 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=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (531.91184997559): 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=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (681.87713623047): 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 (453.94897460938): 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 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

115 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

116 (58.174133300781): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

117 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

118 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

119 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

120 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

121 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

122 (385.99967956543): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 55562.019348145): 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 (643.01490783691): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740344 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740344 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 15051.84173584): ( 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 (63.896179199219): ( 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 (394.82116699219): 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 (77.009201049805): 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 (292.06275939941): 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 (39.815902709961): 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 (244.8558807373): 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 (36.001205444336): 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 (213.1462097168): 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 (36.001205444336): 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 (455.14106750488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (393.15223693848): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (228.8818359375): SELECT name FROM jos_deeppockets WHERE id=214

138 (32.901763916016): SELECT name FROM jos_deeppockets WHERE id=214

139 (532.86552429199): 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 (441.07437133789): 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 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

142 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

143 (!!!!! 17630.100250244): TRUNCATE TABLE jos_trademed_module

144 (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.cat=10 AND dp.id=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (58.889389038086): 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=294740344 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3216.9818878174): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (115.15617370605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

149 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

150 (!!!!! 1272.2015380859): 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 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

152 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

153 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294740344 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294740344 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (36.954879760742): 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 (31.948089599609): 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 (47.922134399414): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (174.04556274414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

158 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294740344 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294740344 AND published='1' LIMIT 1

159 (67.949295043945): select jos_twitters.link from jos_twitters where cat=10

160 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

161 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

162 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

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