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Robotic Arm-Based Remote Echocardiograms Offer Same Diagnostic Accuracy as In-Person Echocardiography

By MedImaging International staff writers
Posted on 03 Sep 2024

Echocardiography, the primary tool for the initial evaluation of many cardiac conditions, typically requires the expertise of a cardiologist for accurate interpretation. More...

However, such expertise can be scarce in rural areas and smaller cities. Previous attempts at robotic arm-assisted remote echocardiograms for teleconsultation were mainly restricted to heart failure patients, largely because of delays related to network latency affecting the control of the robotic arms. Now, new research presented at ESC Congress 2024 demonstrates that echocardiograms conducted remotely using a 5G cellular network and robotic arm can match the accuracy of those performed in person by cardiologists.

In a study by researchers from Zhongshan Hospital (Shanghai, China), the utility and diagnostic precision of a remote echocardiographic system, utilizing a 5G network and robotic arm, were evaluated. This system was operated from an outpatient clinic located 20 kilometers away from the hospital. The study included 51 patients from the outpatient cardiology clinic, each of whom underwent a standard comprehensive echocardiography using the 5G-enhanced robotic system and a traditional echocardiographic setup at Zhongshan Hospital. Patients were randomly assigned to be tested with either the remote or conventional systems first, with no time gap between the two tests. Different cardiologists, blind to each other’s findings, performed the examinations, and the cardiologist using the remote system was randomly chosen without specific prior training. Diagnoses were rendered in real-time immediately following each exam. Of the 51 patients, the image quality was deemed diagnostic in 50 cases. Only one patient was excluded due to the inability to capture essential views remotely, resulting in a 98% technical success rate. About a third (17 patients) were diagnosed with cardiac conditions via conventional echocardiography, with various diagnoses including valvulopathy, post-cardiac surgery conditions, hypertrophic cardiomyopathy, abnormal ventricular wall motion, and congenital heart defects.

Remote echocardiography achieved the same diagnostic outcomes as the conventional method in 98% of the cases, missing only one case of obstruction at the papillary muscle level. Remote imaging took notably longer—about 50% more time than conventional methods (24 minutes and 36 seconds vs. 16 minutes and 15 seconds). While previous iterations of this robotic system have been approved for abdominal scans in several regions, the authors recommend conducting larger, multi-center trials before widespread adoption for cardiac use. They note that while 5G technology is not universally available, it could enhance access to specialist cardiac care by reducing the need for patient travel. Additionally, remote echocardiography could offer increased protection for health workers, particularly during pandemics like COVID-19, by minimizing the need for close physical contact.

“Comprehensive echocardiographic exam with a 5G cellular network and robotic arm-based remote system is feasible with relatively good diagnostic accuracy,” said study author Dr. Yu Liu, Zhongshan Hospital.

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60 (183.10546875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

61 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

62 (137.0906829834): 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 (653.98216247559): SELECT fid FROM jos_deeppockets WHERE id=294802341 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294802341 AND published='1' LIMIT 1

64 (47.922134399414): 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 (73.909759521484): select jos_twitters.link from jos_twitters where cat=10

66 (39.815902709961): select jos_facebook.link from jos_facebook where cat=10

67 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

68 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

69 (36.954879760742): SELECT fid FROM jos_deeppockets WHERE id=294802341 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294802341 AND published='1' LIMIT 1

70 (33.855438232422): 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 (529.05082702637): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (394.10591125488): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (49.114227294922): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

74 (85.830688476562): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (48.87580871582): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (37.193298339844): 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 (58.174133300781): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

106 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

107 (54.121017456055): 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=294802341 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (50.067901611328): 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=294802341 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

110 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

111 (52.928924560547): 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=294802341 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (535.96496582031): 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=294802341 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (726.93824768066): 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 (483.98971557617): 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 (158.07151794434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

116 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

117 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

118 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

119 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

120 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

121 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

122 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

123 (452.04162597656): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 24491.07170105): 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 (741.95861816406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802341 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802341 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 8368.968963623): ( 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 (79.154968261719): ( 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 (41.961669921875): 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 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (46.014785766602): 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 (30.040740966797): 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 (323.05717468262): 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 (64.13459777832): 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 (46.968460083008): 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 (30.040740966797): 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 (617.02728271484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (458.95576477051): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (57.93571472168): SELECT name FROM jos_deeppockets WHERE id=214

139 (38.14697265625): SELECT name FROM jos_deeppockets WHERE id=214

140 (610.8283996582): 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 (522.13668823242): 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 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

143 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

144 (!!!!! 10511.159896851): TRUNCATE TABLE jos_trademed_module

145 (263.21411132812): 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=294802341 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (77.009201049805): 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=294802341 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (552.89268493652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (112.05673217773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (164.98565673828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

150 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

151 (!!!!! 1564.9795532227): 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 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

153 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

154 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294802341 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294802341 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (51.975250244141): 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 (45.061111450195): 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 (59.127807617188): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (97.990036010742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

159 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294802341 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294802341 AND published='1' LIMIT 1

160 (91.075897216797): select jos_twitters.link from jos_twitters where cat=10

161 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

162 (33.855438232422): select jos_google_plus.link from jos_google_plus where cat=10

163 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

164 (371.93298339844): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

165 (!!!!! 1317.024230957): insert into jos_banners_delta values (14202,'2025-08-02 18:41:06','216.73.216.210','view'),(14203,'2025-08-02 18:41:06','216.73.216.210','view')

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