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MRI-Guided Focused Ultrasound Procedure Offers Long-Term Relief for Patients with Essential Tremor

By MedImaging International staff writers
Posted on 11 Nov 2022

Image: Jeff Elias, MD, has pioneered the use of focused ultrasound for essential tremor (Photo courtesy of UVA Health)

A scalpel-free, high-tech form of brain surgery offers long-term relief for patients with essential tremor, a common movement disorder, a five-year review shows. The study offers important insights into the durability of the benefits of focused ultrasound treatment for essential tremor.

The use of focused ultrasound procedure for essential tremor was pioneered by UVA Health (Charlottesville, VA, USA) and focuses sound waves inside the brain to disrupt faulty brain circuits that cause unwanted movement. Unlike traditional brain surgery, it does not require incisions or opening the skull. The minimally invasive procedure is guided by magnetic resonance imaging (MRI), so doctors can pinpoint the exact right spot in the brain before delivering the treatment. Initial tests of the procedure at UVA and a small number of other sites often produced dramatic results: Study participants would enter an MRI with their hand shaking uncontrollably and emerge with their ability to write or feed themselves restored.

The pioneering clinical trials at UVA and a handful of other sites paved the way for the federal Food and Drug Administration to approve focused ultrasound for the treatment of essential tremor in 2016. That made the procedure available to patients outside clinical trials, though there are still a limited number of hospitals with the advanced technology and expertise needed to offer it. The FDA also has approved focused ultrasound for the treatment of Parkinson’s disease tremor and dyskinesia (involuntary movements) based on research at UVA Health and elsewhere.

While promising, those early tests could not reveal how long the benefits of the procedure would last. This new study followed the clinical trial participants for five years and found that they continued to enjoy major reduction of more than 70% in their tremors. Other measures of quality of life were improved as well. Side effects did not occur after the procedure was complete. The study described the outcomes of 40 trial participants from the original study cohort. It represents the largest long-term follow-up study of the procedure, known as “unilateral thalamotomy,” possible to conduct so far.

UVA is now investigating the technology’s potential for a wide variety of other medical applications, from treating cancer to opening the brain’s protective barrier to deliver now-impossible treatments for diseases such as Alzheimer’s. Based on its highly promising research, UVA launched the world’s first focused ultrasound cancer immunotherapy center earlier this year. The center aims to combine focused ultrasound with immunotherapy to enhance the immune system’s ability to battle cancers.

“It is exciting to see such durable results after an outpatient procedure for a sometimes disabling problem like ET,” said researcher Jeff Elias, MD, a UVA Health neurosurgeon who served as the study’s Principle Investigator. “It is important to note that most of the patients had very long-lasting benefits, but there are some cases where tremor can recur.”

“This important trial verifies the long-term benefits and safety of the focused ultrasound procedure that we have performed for hundreds of patients with tremor at UVA,” said Shayan Moosa, MD, a UVA Health neurosurgeon partnering with Elias to perform focused ultrasound procedures. “As this is an incision-less and outpatient treatment, we are able to effectively reduce tremor in patients who may not be able to or may not want to pursue more-invasive options."

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59 (!!!!! 5533.9336395264): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

60 (!!!!! 7907.8674316406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

61 (!!!!! 6707.9067230225): 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 (!!!!! 4256.010055542): SELECT fid FROM jos_deeppockets WHERE id=294795296 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294795296 AND published='1' LIMIT 1

63 (!!!!! 7263.8988494873): 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 (!!!!! 7999.8970031738): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 7610.0826263428): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 8085.0124359131): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 7789.8502349854): select jos_linkedin.link from jos_linkedin where cat=10

68 (!!!!! 8454.0843963623): SELECT fid FROM jos_deeppockets WHERE id=294795296 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294795296 AND published='1' LIMIT 1

69 (!!!!! 7441.0438537598): 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 (!!!!! 8231.1630249023): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 10968.923568726): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 12485.980987549): 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 (!!!!! 8449.0776062012): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (!!!!! 7877.1114349365): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 8495.8076477051): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (!!!!! 4755.973815918): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (!!!!! 6579.1606903076): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 8204.9369812012): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (!!!!! 7646.0838317871): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 6067.9912567139): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 2517.9386138916): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (524.99771118164): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (!!!!! 1950.0255584717): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (!!!!! 4495.8591461182): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (!!!!! 7855.8921813965): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (!!!!! 9734.1537475586): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 2753.9730072021): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (!!!!! 8098.1254577637): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (918.86520385742): 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 (!!!!! 3287.0769500732): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3821.849822998): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (65.088272094727): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (313.99726867676): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (47.206878662109): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (283.95652770996): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2475.0232696533): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

105 (251.05476379395): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

106 (303.98368835449): 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=294795296 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (653.98216247559): 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=294795296 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (982.99980163574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

109 (234.12704467773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

110 (328.06396484375): 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=294795296 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (941.99180603027): 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=294795296 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 1507.9975128174): 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 (!!!!! 1756.1912536621): 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 (106.0962677002): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

115 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

116 (977.99301147461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

117 (771.99935913086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

118 (445.84274291992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

119 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

120 (493.04962158203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

121 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

122 (!!!!! 3156.9004058838): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 92563.86756897): 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 (!!!!! 2596.1399078369): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795296 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795296 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (64.849853515625): ( 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 (48.87580871582): ( 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 (313.04359436035): 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 (48.87580871582): 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 (501.15585327148): 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 (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

131 (510.93101501465): 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 (47.922134399414): 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 (354.05158996582): 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 (49.829483032227): 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 (!!!!! 3656.8641662598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (908.13636779785): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (537.87231445312): SELECT name FROM jos_deeppockets WHERE id=214

138 (234.84230041504): SELECT name FROM jos_deeppockets WHERE id=214

139 (948.90594482422): 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 (987.05291748047): 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 (!!!!! 1312.9711151123): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

142 (739.09759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

143 (!!!!! 16637.802124023): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 13036.012649536): 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=294795296 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 1453.8764953613): 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=294795296 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3690.0043487549): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (226.97448730469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (752.21061706543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

149 (267.02880859375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

150 (!!!!! 4036.9033813477): 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 (!!!!! 10079.145431519): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

152 (!!!!! 1039.0281677246): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

153 (91.075897216797): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294795296 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294795296 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (797.03330993652): 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 (65.803527832031): 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 (65.088272094727): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1212.1200561523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

158 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294795296 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294795296 AND published='1' LIMIT 1

159 (92.029571533203): select jos_twitters.link from jos_twitters where cat=10

160 (50.067901611328): select jos_facebook.link from jos_facebook where cat=10

161 (47.922134399414): select jos_google_plus.link from jos_google_plus where cat=10

162 (49.114227294922): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 5394.9356079102): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

164 (!!!!! 1694.917678833): insert into jos_banners_delta values (14202,'2025-08-04 04:27:21','216.73.216.210','view'),(14203,'2025-08-04 04:27:21','216.73.216.210','view')

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