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Ultrasound Imaging of Blood Flow Provides New Clues into Cardiac Abnormalities, Dysfunction

By MedImaging International staff writers
Posted on 12 Jun 2012

US cardiologists are innovating new ultrasound techniques that provide the first characterization of multidirectional blood flow in the heart. More...

By concentrating on fluid dynamics--specifically, the researchers believe they can detect heart disease even when conventional diagnostics reveal no sign of abnormality.

In addition to improving diagnoses, this move in focus from muscle mechanics to fluid mechanics could lead to more effective therapeutic interventions. The study’s findings were published by two Mount Sinai School of Medicine (New York, NY, USA) cardiologists and a team of international collaborators in a recent issue of JACC Cardiovascular Imaging, a journal of the American College of Cardiology.

The ultrasound strategies cardiologists employ today frequently cannot identify changes in the heart until there is overt dysfunction. Blood flow imaging, however, may provide better clues in diagnosing heart failure. Sinai investigators reason that flow should be immediately affected by changes in cardiac function--such as those revealed in image analysis by the chaotic behavior of tiny whirlpools.

The computer-aided visual study of these abnormalities could dramatically improve the assessment of patients with heart failure and lead to a fresh understanding of normal and abnormal pumping and circulatory function. Visual blood-flow analysis could also yield improved therapies for arrhythmias and other disorders requiring cardiac synchronization. Researchers are actively exploring applications in aortic atherosclerosis, before and after valve replacement, and congenital abnormalities.

“With visualization, we are looking at the ultimate measure of the efficiency of the heart - how the blood is brought in and how it is sent out,” said Jagat Narula, MD, PhD, director of cardiovascular imaging at Mount Sinai and the senior author of the paper. “Today, cardiologists place great weight on a gauge called the squeeze fraction, or ejection fraction--the portion of blood pumped from the ventricle with each heartbeat. What we are doing is a complete departure from the view of the heart as a squeezing, pressure-generating chamber.”

Mount Sinai researchers and their collaborators have experimented with a range of imaging techniques to grasp the characteristics of normal and abnormal blood flow. The approaches include phase-encoded MRI, cardiac magnetic resonance (CMR) and several forms of ultrasound-based imaging known as echocardiographic particle imaging velocimetry.

“The most effective technique involves injecting a stream of bubbles that behave exactly like red blood cells and using echocardiography to track their path through the left ventricle,” said Partho Sengupta, MD, director of cardiac ultrasound research at Mount Sinai, and the first author, with Narula, of the JACC article. In these studies, the computer-enhanced video output portrays normal and turbulent flow in vivid detail, with arrows plotting the direction as the bubbles swirl through the heart chamber.

“Not only are you following the path of the blood, but you can actually identify the amount of energy that is being distributed,” said Dr. Sengupta. “Like other forms of ultrasound, that means low-cost heart tests using this technology could be performed on a simple outpatient basis.”

The echocardiography technology pioneered by Drs. Sengupta and Narula sheds light on diagnostic discrepancies that have puzzled cardiologists relying on pressure measurements. “After sustaining significant damage, a patient's heart may not have the greatest squeeze, but there could be good trafficking of blood through the heart and the patient could remain asymptomatic,” Dr. Sengupta explained. “The normal ejection fraction is around 60%, but we sometimes see a patient with 20% walking around and playing golf. Other people who are at 50% may be short of breath. Flow visualization is one way to capture the essence of why the patient is or is not symptomatic.”

Diagnosing cardiac disease by searching for structural defects in the heart is similar to analyzing highway traffic by examining the road, Dr. Narula said. “The structure may not be great, but how does that affect the cars that are actually traveling on the road? It’s the same thing if you fail to look at the blood.”

Similarly, a plumber’s search into pipes only matters or makes sense in relation to how the water flows, noted Dr. Sengupta. A new study these investigators hones in on specific correlations between blood flow and cardiac pathology. “We will be able to demonstrate that efficiency may be lost even though the structure is maintained,” said Dr. Senguptra. “In other words, the façade is good, but inside, you have lost it.”

Dr. Sengupta stressed that the combined visualization and computation techniques in the study are still new and require additional study, including development of appropriate flow-based indexes for applications in various cardiac disorders. Forces acting on flow are extremely complicated and dynamic, according to the researchers. Pumped by the heart at a rate of 3,785-7,571 cm³ per minute, blood interacts with the contours of the valves, myocardium, vessels, and other areas, which are also in motion. The flow is multidirectional--curling, spinning, and forming eddies that are affected in innumerable ways by structural changes in heart tissue. As with any new observational techniques, data from novel cardiac visualizations in complex environments are subject to interpretation.

“We have started using these imaging techniques in clinical trials,” Dr. Narula said. “They will require careful evaluation.”

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55 (50.067901611328): 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'

56 (62.942504882812): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (456.09474182129): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1292.9439544678): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

59 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

60 (151.15737915039): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

61 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

62 (95.129013061523): 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 (665.90309143066): SELECT fid FROM jos_deeppockets WHERE id=294741089 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294741089 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 (44.107437133789): select jos_twitters.link from jos_twitters where cat=10

66 (30.994415283203): 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 (!!!!! 1407.1464538574): select jos_linkedin.link from jos_linkedin where cat=10

69 (65.088272094727): SELECT fid FROM jos_deeppockets WHERE id=294741089 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294741089 AND published='1' LIMIT 1

70 (35.04753112793): 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 (371.93298339844): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (235.79597473145): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (38.14697265625): 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 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): 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 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (46.968460083008): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (33.140182495117): 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 (55.074691772461): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (83.92333984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (52.213668823242): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

106 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

107 (54.836273193359): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (56.028366088867): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

110 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

111 (62.942504882812): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (610.1131439209): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (787.97340393066): 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 (425.81558227539): 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 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

116 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

117 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

118 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

119 (48.160552978516): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

120 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

121 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

122 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

123 (313.99726867676): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 43293.952941895): 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 (!!!!! 1228.8093566895): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741089 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741089 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 18930.912017822): ( 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 (77.009201049805): ( 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 (46.968460083008): 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 (46.014785766602): 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 (!!!!! 2087.8314971924): 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 (51.021575927734): 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 (306.84471130371): 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 (36.954879760742): 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 (35.04753112793): 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 (31.948089599609): 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 (496.14906311035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (374.07875061035): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (47.922134399414): SELECT name FROM jos_deeppockets WHERE id=214

139 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=214

140 (566.95938110352): 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 (663.04206848145): 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 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

143 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

144 (!!!!! 17991.065979004): TRUNCATE TABLE jos_trademed_module

145 (!!!!! 3712.8925323486): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3148.078918457): 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=294741089 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 2367.0196533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (109.91096496582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (!!!!! 1065.0157928467): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

150 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

151 (!!!!! 1204.9674987793): 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 (!!!!! 1013.9942169189): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

153 (535.01129150391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

154 (586.03286743164): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741089 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741089 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (970.84045410156): 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 (64.13459777832): 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 (!!!!! 2180.0994873047): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (187.87384033203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

159 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741089 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741089 AND published='1' LIMIT 1

160 (565.0520324707): select jos_twitters.link from jos_twitters where cat=10

161 (46.014785766602): select jos_facebook.link from jos_facebook where cat=10

162 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

163 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

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