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Focused Ultrasound Can Lessen Cancer Pain

By MedImaging International staff writers
Posted on 19 May 2014

Image: Day of treatment pre- and post-procedure MR imaging. Axial T1-weighted contrast-enhanced MR images demonstrating a right ischial metastasis (black arrow) before treatment (left) and immediately after magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment (right). The post-treatment image shows nonenhancement of the lesion, which was targeted from a posterior approach. Each hash mark on the scale bars represents 1 cm (Photo courtesy of Journal of the US National Cancer Institute (JNCI)).

When cancer advances and metastasizes to the bone, patients often suffer debilitating pain. Now, a new phase III clinical trial shows that noninvasive magnetic resonance-guided focused ultrasound treatment that heats the cancer within the bone relieves pain and improves function for most patients when other treatment alternatives are limited.

The study’s findings were first published online April 23, 2014, in the Journal of the National Cancer Institute (JNCI).Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a technique that is been safely used to treat thousands of women with uterine fibroids. However, “this is the first phase III study to use this technology in the treatment of cancer,” noted the study’s principal investigator and lead author Mark Hurwitz, MD, vice chairman of quality, safety, and performance and director of thermal oncology in the department of radiation oncology at Thomas Jefferson University (Philadelphia, PA, USA).

Although radiotherapy is typically used to treat bone-related pain and effective for most patients, not all patients experience pain relief and over time those who do may have recurrence of pain. In addition, it's possible for a patient to receive the maximum radiation dose that can be safely delivered without fully controlling the pain. In situations where radiation therapy is not an option, alternative treatments are required.

A total of 147 patients from 17 centers in the US, Canada, Israel, Italy, and Russia were enrolled in the study and randomized to undergo MRgFUS or a sham treatment. Patients in the treatment group received focused ultrasound precisely targeted to their bone tumors to heat the tumor tissue to between 65 °C and 85 °C, resulting in its obliteration. During each treatment, the patients were tracked real-time via magnetic resonance imaging (MRI) to make sure the appropriate tissue was targeted and the right temperatures were reached while ensuring heat in surrounding normal tissues and organs remained at safe levels. The control group underwent the same procedure but without the ultrasound device turned on. Finally, patients who did not respond to the placebo treatment within two weeks were allowed to be unblinded and offered MRgFUS.

Patients responded well to treatment, with 64% experiencing either no pain or a significant reduction in their pain at three months as gauged by a 2 point or greater decrease in the numeric rating score (NRS) for pain, a clinically validated measurement tool. Many patients were able to reduce or stop use of opiod medications. Significantly, most patients experienced pain relief and improved functioning within several days of treatment. “It’s clear that for many of these patients, pain has a major impact on their everyday lives," says Dr. Hurwitz. “This approach offers a new way to help alleviate that pain via an out-patient noninvasive procedure.”

The next phase in this research, according to Dr. Hurwitz, is to modify the treatment technique to get an even greater response rate, and to apply radiation and thermal therapy together in treatment of bone metastases noting the established clinical benefits for other malignant conditions with this combination. To achieve this, Dr. Jefferson has established a new program for thermal oncology within its department of radiation oncology to provide patients with access to thermal therapies that have been shown to augment radiation treatment.

“The work provides cancer patients with more options for treatment of cancer pain and the opportunity for patients to reduce opioid use, which has significant side effects,” said Adam Dicker, MD, PhD, chair of Jefferson’s department of radiation oncology, and not involved in the study.

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57 (535.01129150391): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (431.06079101562): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 3065.824508667): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

60 (417.94776916504): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

61 (!!!!! 7868.0515289307): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

62 (437.97492980957): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

63 (!!!!! 1950.0255584717): 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

64 (966.78733825684): SELECT fid FROM jos_deeppockets WHERE id=294752507 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752507 AND published='1' LIMIT 1

65 (247.95532226562): 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`

66 (!!!!! 1440.0482177734): select jos_twitters.link from jos_twitters where cat=10

67 (39.100646972656): select jos_facebook.link from jos_facebook where cat=10

68 (105.85784912109): select jos_google_plus.link from jos_google_plus where cat=10

69 (236.98806762695): select jos_linkedin.link from jos_linkedin where cat=10

70 (764.13154602051): SELECT fid FROM jos_deeppockets WHERE id=294752507 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294752507 AND published='1' LIMIT 1

71 (694.99015808105): 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`

72 (!!!!! 3689.0506744385): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (539.06440734863): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (303.98368835449): 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`

75 (57.220458984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (123.97766113281): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (403.88107299805): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1829.1473388672): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (349.99847412109): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (466.10832214355): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (156.87942504883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (525.95138549805): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (159.02519226074): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (330.92498779297): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (!!!!! 1287.9371643066): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (92.029571533203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (436.78283691406): 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`

92 (!!!!! 5176.0673522949): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (449.89585876465): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (183.10546875): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (322.10350036621): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (!!!!! 2988.1000518799): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

107 (113.96408081055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

108 (423.90823364258): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (73.19450378418): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (571.01249694824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

111 (380.03921508789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

112 (!!!!! 2054.2144775391): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (952.00538635254): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (745.05805969238): 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 (!!!!! 4293.9186096191): 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

116 (492.09594726562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

117 (439.88227844238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

118 (!!!!! 3424.8828887939): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

119 (!!!!! 1528.9783477783): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

120 (413.89465332031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

121 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

122 (!!!!! 1586.9140625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

123 (180.00602722168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

124 (607.01370239258): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 84935.903549194): 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

126 (!!!!! 1555.9196472168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752507 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752507 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 23517.847061157): ( 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 (232.93495178223): ( 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

129 (162.12463378906): 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 (140.19012451172): 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

131 (63.896179199219): 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 (132.08389282227): 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

133 (715.01731872559): 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 (299.21531677246): 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

135 (54.836273193359): 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 (38.862228393555): 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

137 (!!!!! 1067.8768157959): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (397.92060852051): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (41.961669921875): SELECT name FROM jos_deeppockets WHERE id=214

140 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=214

141 (782.01293945312): 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 (492.09594726562): 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

143 (160.93254089355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

144 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

145 (!!!!! 15214.204788208): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 7066.9651031494): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (142.09747314453): 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=294752507 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (488.0428314209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (357.86628723145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (181.91337585449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

151 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

152 (!!!!! 1266.9563293457): 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

153 (411.9873046875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

154 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

155 (336.88545227051): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294752507 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294752507 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (34.093856811523): 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 (30.040740966797): 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)

158 (108.00361633301): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (413.17939758301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

160 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294752507 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294752507 AND published='1' LIMIT 1

161 (841.14074707031): select jos_twitters.link from jos_twitters where cat=10

162 (51.975250244141): select jos_facebook.link from jos_facebook where cat=10

163 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

164 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

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