Renée Fleming, Kelli O'Hara, Joyce DiDonato
Yannick Nézet-Séguin, Metropolitan Opera Orchestra & Chorus
Yannick Nézet-Séguin - Puts: The Hours (24-48)
2024
Kevin Puts
01 The Hours: Act 1, Prologue. 'Flowers... Flowers' (Chorus)
02 The Hours: Act 1, 'Platters! - What's That, Babe?' (Clarissa, Sally, Chorus)
03 The Hours: Act 1, 'She Pauses at Its Threshold…' (Chorus, Clarissa, Man Under the Arch, Walter, Virginia)
04 The Hours: Act 1, 'Go Slowly. Ignore Your Novel' (Virginia, Clarissa, Chorus, Leonard)
05 The Hours: Act 1, 'There's the Scowl' (Virginia, Leonard, Chorus)
06 The Hours: Act 1, 'Clarissa! - Barbara!' (Barbara, Clarissa, Chorus, Virginia, Leonard)
07 The Hours: Act 1, 'Richmond… She Opens the Curtains' (Virginia, Chorus, Man Under the Arch)
08 The Hours: Act 1, 'Missus Dalloway Said She Would Buy the Flowers Herself' (Laura, Virginia, Chorus, Dan, Richie)
09 The Hours: Act 1, 'Oh Dan. Roses? On Your Birthday?' (Laura, Dan, Richie, Chorus)
10 The Hours: Act 1, 'You Know What We're Going to Do?' (Laura, Virginia, Richie, Clarissa)
11 The Hours: Act 1, 'Here on This Corner' (Clarissa)
12 The Hours: Act 1, 'Good Morning, My Love!' (Clarissa, Richard, Angelica, Quentin, Julian)
13 The Hours: Act 1, 'We Need Four Cups' (Laura, Richie, Chorus, Nelly, Virginia)
14 The Hours: Act 1, 'Oh! A Reminder, Ma'am, Your Sister's Coming at Two' (Nelly, Virginia, Richie, Laura, Kitty, Chorus, Angelica, Quentin, Julian, Man Under the Arch)
15 The Hours: Act 1, '...'Cause I'm Going to Die' (Chorus, Clarissa, Sally)
16 The Hours: Act 2, 'Heaven? Somebody Else's Heaven?' (Chorus, Laura, Hotel Clerk)
17 The Hours: Act 2, 'Did It Matter Then, She Asked Herself' (Laura, Virginia)
18 The Hours: Act 2, 'It's Happened - I Thought I'd Be Overjoyed, Richard!' (Leonard, Clarissa, Chorus)
19 The Hours: Act 2, 'Louis? - Clarissa. Caught Me Smoking' (Clarissa, Louis, Chorus)
20 The Hours: Act 2, 'Ent(ha)da oikeîs en te ge' (Chorus, Angelica, Quentin, Julian, Virginia, Vanessa, Laura)
21 The Hours: Act 2, 'Richard! Get Down from There' (Clarissa, Richard)
22 The Hours: Act 2, 'For Alone You Are Holy…' (Chorus, Man Under the Arch)
23 The Hours: Act 2, 'Mm... 'Stead of Jousting You'd Rather…' (Mrs. Latch, Richie, Laura, Clarissa, Virginia, Leonard, Nelly)
24 The Hours: Act 2, 'Happy My Birthday!' (Dan, Richie, Walter, Sally, Louis, Clarissa, Virginia, Leonard, Laura)
25 The Hours: Act 2, 'This Is My Partner, Sally' (Clarissa, Sally, Laura, Dan, Leonard)
26 The Hours: Act 2, 'All Along?' (Clarissa, Laura, Virginia)
Yannick Nézet-Séguin, Metropolitan Opera Orchestra & Chorus
Yannick Nézet-Séguin - Puts: The Hours (24-48)
2024
Kevin Puts
01 The Hours: Act 1, Prologue. 'Flowers... Flowers' (Chorus)
02 The Hours: Act 1, 'Platters! - What's That, Babe?' (Clarissa, Sally, Chorus)
03 The Hours: Act 1, 'She Pauses at Its Threshold…' (Chorus, Clarissa, Man Under the Arch, Walter, Virginia)
04 The Hours: Act 1, 'Go Slowly. Ignore Your Novel' (Virginia, Clarissa, Chorus, Leonard)
05 The Hours: Act 1, 'There's the Scowl' (Virginia, Leonard, Chorus)
06 The Hours: Act 1, 'Clarissa! - Barbara!' (Barbara, Clarissa, Chorus, Virginia, Leonard)
07 The Hours: Act 1, 'Richmond… She Opens the Curtains' (Virginia, Chorus, Man Under the Arch)
08 The Hours: Act 1, 'Missus Dalloway Said She Would Buy the Flowers Herself' (Laura, Virginia, Chorus, Dan, Richie)
09 The Hours: Act 1, 'Oh Dan. Roses? On Your Birthday?' (Laura, Dan, Richie, Chorus)
10 The Hours: Act 1, 'You Know What We're Going to Do?' (Laura, Virginia, Richie, Clarissa)
11 The Hours: Act 1, 'Here on This Corner' (Clarissa)
12 The Hours: Act 1, 'Good Morning, My Love!' (Clarissa, Richard, Angelica, Quentin, Julian)
13 The Hours: Act 1, 'We Need Four Cups' (Laura, Richie, Chorus, Nelly, Virginia)
14 The Hours: Act 1, 'Oh! A Reminder, Ma'am, Your Sister's Coming at Two' (Nelly, Virginia, Richie, Laura, Kitty, Chorus, Angelica, Quentin, Julian, Man Under the Arch)
15 The Hours: Act 1, '...'Cause I'm Going to Die' (Chorus, Clarissa, Sally)
16 The Hours: Act 2, 'Heaven? Somebody Else's Heaven?' (Chorus, Laura, Hotel Clerk)
17 The Hours: Act 2, 'Did It Matter Then, She Asked Herself' (Laura, Virginia)
18 The Hours: Act 2, 'It's Happened - I Thought I'd Be Overjoyed, Richard!' (Leonard, Clarissa, Chorus)
19 The Hours: Act 2, 'Louis? - Clarissa. Caught Me Smoking' (Clarissa, Louis, Chorus)
20 The Hours: Act 2, 'Ent(ha)da oikeîs en te ge' (Chorus, Angelica, Quentin, Julian, Virginia, Vanessa, Laura)
21 The Hours: Act 2, 'Richard! Get Down from There' (Clarissa, Richard)
22 The Hours: Act 2, 'For Alone You Are Holy…' (Chorus, Man Under the Arch)
23 The Hours: Act 2, 'Mm... 'Stead of Jousting You'd Rather…' (Mrs. Latch, Richie, Laura, Clarissa, Virginia, Leonard, Nelly)
24 The Hours: Act 2, 'Happy My Birthday!' (Dan, Richie, Walter, Sally, Louis, Clarissa, Virginia, Leonard, Laura)
25 The Hours: Act 2, 'This Is My Partner, Sally' (Clarissa, Sally, Laura, Dan, Leonard)
26 The Hours: Act 2, 'All Along?' (Clarissa, Laura, Virginia)
NEW ARTICLE: BROMELAIN and CANCER - Recent Research
Many COVID-19 mRNA Vaccine Injured are already taking the pineapple derived proteolytic enzyme BROMELAIN to help break down the spike protein.
However, Bromelain also has anti-cancer properties that have been evaluated extensively in dozens of studies in vitro for:
breast cancer, prostate cancer, gastric, colorectal, hepatocellular, cholangiocarcinoma, lung, melanoma, lymphoma and leukemia
The ability of Bromelain to inhibit tumor cell proliferation and metastasis, and induce tumor cell death may be due to its unique proteolytic and immunomodulatory properties
"Bromelain’s ability to trigger apoptosis is undoubtedly one of its essential features allowing for effective inhibition of cancer development and proliferation"
"molecular mechanisms of bromelain’s anticancer activity are carried out in many biochemical pathways":
- induce apoptosis (internal and external pathways)
- induce autophagy
- induce ferroptosis
- upregulate expression of p53 tumor suppressor
- induce cell cycle arrest
- immune modulator
- anti-inflammatory
- chemo sensitizer
- radiation therapy sensitizer
BROMELAIN also has some very unique synergistic effects with other bioactive compounds:
bromelain + peroxidase: increase ROS, upregulate p53 - effective against leukemias and lymphomas
bromelain + olive leaf: decreased lung carcinogenesis in mice
bromelain + curcumin + harpagophytum (devil's claw): reduced inflammation in cancer patients
bromelain + NAC (N-acetyl cysteine): inhibits growth and proliferation of certain mucinous tumors (gastric and colorectal)
bromelain + cisplatin: enhanced chemotherapy effect in breast cancer (enhances the effect of chemo while decreasing chemo related side effects)
"Due to its low toxicity, high efficiency, high availability, and relative simplicity of acquisition, it is the object of inexhaustible interest of scientists"
COVID-19 mRNA Vaccinated individuals who develop Turbo Cancer after mRNA vaccination, can benefit as BROMELAIN serves two key functions:
1. Vaccine Spike protein detoxification due to its enzymatic activity
2. Broad anti-cancer activity against common Turbo Cancers such as Lymphomas and Leukemias, Breast Cancer, Colorectal Cancer, Pancreatic Cancer, Lung Cancer and more.
BROMELAIN is under extensive research right now and you'll see from the article why.
新文章：菠萝蛋白酶和癌症 - 最新研究
许多 COVID-19 mRNA 疫苗受害者已经开始服用菠萝衍生的蛋白水解酶菠萝蛋白酶来帮助分解刺突蛋白。
然而，菠萝蛋白酶还具有抗癌特性，这已在数十项体外研究中得到广泛评估：
乳腺癌、前列腺癌、胃癌、结直肠癌、肝细胞癌、胆管癌、肺癌、黑色素瘤、淋巴瘤和白血病
菠萝蛋白酶能够抑制肿瘤细胞增殖和转移，并诱导肿瘤细胞死亡，这可能是由于其独特的蛋白水解和免疫调节特性
“菠萝蛋白酶引发细胞凋亡的能力无疑是其有效抑制癌症发展和增殖的重要特征之一”
“菠萝蛋白酶抗癌活性的分子机制是通过多种生化途径进行的”：
- 诱导细胞凋亡（内部和外部途径）
- 诱导自噬
- 诱导铁死亡
- 上调 p53 肿瘤抑制因子的表达
- 诱导细胞周期停滞
- 免疫调节剂
- 消炎（药
- 化学增敏剂
- 放射治疗增敏剂
菠萝蛋白酶还与其他生物活性化合物具有一些非常独特的协同作用：
菠萝蛋白酶 + 过氧化物酶：增加 ROS，上调 p53 - 有效对抗白血病和淋巴瘤
菠萝蛋白酶+橄榄叶：降低小鼠肺癌致癌性
菠萝蛋白酶 + 姜黄素 + 魔爪草：减轻癌症患者的炎症
菠萝蛋白酶 + NAC（N-乙酰半胱氨酸）：抑制某些粘液肿瘤（胃癌和结直肠癌）的生长和增殖
菠萝蛋白酶+顺铂：增强乳腺癌化疗效果（增强化疗效果，同时减少化疗相关的副作用）
“由于其毒性低、效率高、可用性高、获取相对简单，因此成为科学家们无穷无尽兴趣的对象”
接种 COVID-19 mRNA 疫苗后患上涡轮癌的个体可以受益，因为菠萝蛋白酶具有两项关键功能：
1. 疫苗刺突蛋白因其酶活性而具有解毒作用
2. 对常见的 Turbo 癌症（例如淋巴瘤和白血病、乳腺癌、结直肠癌、胰腺癌、肺癌等）具有广泛的抗癌活性。
目前，菠萝蛋白酶正受到广泛研究，您可以从文章中看到原因。
Many COVID-19 mRNA Vaccine Injured are already taking the pineapple derived proteolytic enzyme BROMELAIN to help break down the spike protein.
However, Bromelain also has anti-cancer properties that have been evaluated extensively in dozens of studies in vitro for:
breast cancer, prostate cancer, gastric, colorectal, hepatocellular, cholangiocarcinoma, lung, melanoma, lymphoma and leukemia
The ability of Bromelain to inhibit tumor cell proliferation and metastasis, and induce tumor cell death may be due to its unique proteolytic and immunomodulatory properties
"Bromelain’s ability to trigger apoptosis is undoubtedly one of its essential features allowing for effective inhibition of cancer development and proliferation"
"molecular mechanisms of bromelain’s anticancer activity are carried out in many biochemical pathways":
- induce apoptosis (internal and external pathways)
- induce autophagy
- induce ferroptosis
- upregulate expression of p53 tumor suppressor
- induce cell cycle arrest
- immune modulator
- anti-inflammatory
- chemo sensitizer
- radiation therapy sensitizer
BROMELAIN also has some very unique synergistic effects with other bioactive compounds:
bromelain + peroxidase: increase ROS, upregulate p53 - effective against leukemias and lymphomas
bromelain + olive leaf: decreased lung carcinogenesis in mice
bromelain + curcumin + harpagophytum (devil's claw): reduced inflammation in cancer patients
bromelain + NAC (N-acetyl cysteine): inhibits growth and proliferation of certain mucinous tumors (gastric and colorectal)
bromelain + cisplatin: enhanced chemotherapy effect in breast cancer (enhances the effect of chemo while decreasing chemo related side effects)
"Due to its low toxicity, high efficiency, high availability, and relative simplicity of acquisition, it is the object of inexhaustible interest of scientists"
COVID-19 mRNA Vaccinated individuals who develop Turbo Cancer after mRNA vaccination, can benefit as BROMELAIN serves two key functions:
1. Vaccine Spike protein detoxification due to its enzymatic activity
2. Broad anti-cancer activity against common Turbo Cancers such as Lymphomas and Leukemias, Breast Cancer, Colorectal Cancer, Pancreatic Cancer, Lung Cancer and more.
BROMELAIN is under extensive research right now and you'll see from the article why.
新文章：菠萝蛋白酶和癌症 - 最新研究
许多 COVID-19 mRNA 疫苗受害者已经开始服用菠萝衍生的蛋白水解酶菠萝蛋白酶来帮助分解刺突蛋白。
然而，菠萝蛋白酶还具有抗癌特性，这已在数十项体外研究中得到广泛评估：
乳腺癌、前列腺癌、胃癌、结直肠癌、肝细胞癌、胆管癌、肺癌、黑色素瘤、淋巴瘤和白血病
菠萝蛋白酶能够抑制肿瘤细胞增殖和转移，并诱导肿瘤细胞死亡，这可能是由于其独特的蛋白水解和免疫调节特性
“菠萝蛋白酶引发细胞凋亡的能力无疑是其有效抑制癌症发展和增殖的重要特征之一”
“菠萝蛋白酶抗癌活性的分子机制是通过多种生化途径进行的”：
- 诱导细胞凋亡（内部和外部途径）
- 诱导自噬
- 诱导铁死亡
- 上调 p53 肿瘤抑制因子的表达
- 诱导细胞周期停滞
- 免疫调节剂
- 消炎（药
- 化学增敏剂
- 放射治疗增敏剂
菠萝蛋白酶还与其他生物活性化合物具有一些非常独特的协同作用：
菠萝蛋白酶 + 过氧化物酶：增加 ROS，上调 p53 - 有效对抗白血病和淋巴瘤
菠萝蛋白酶+橄榄叶：降低小鼠肺癌致癌性
菠萝蛋白酶 + 姜黄素 + 魔爪草：减轻癌症患者的炎症
菠萝蛋白酶 + NAC（N-乙酰半胱氨酸）：抑制某些粘液肿瘤（胃癌和结直肠癌）的生长和增殖
菠萝蛋白酶+顺铂：增强乳腺癌化疗效果（增强化疗效果，同时减少化疗相关的副作用）
“由于其毒性低、效率高、可用性高、获取相对简单，因此成为科学家们无穷无尽兴趣的对象”
接种 COVID-19 mRNA 疫苗后患上涡轮癌的个体可以受益，因为菠萝蛋白酶具有两项关键功能：
1. 疫苗刺突蛋白因其酶活性而具有解毒作用
2. 对常见的 Turbo 癌症（例如淋巴瘤和白血病、乳腺癌、结直肠癌、胰腺癌、肺癌等）具有广泛的抗癌活性。
目前，菠萝蛋白酶正受到广泛研究，您可以从文章中看到原因。
胆囊穿孔
是急性胆囊炎胆石症的罕见并发症，发病率和死亡率较高，但没有特定的病理学特征，经常被误诊或晚期诊断。
最常用的是 Niemeier 分类。1934年，他将GBP穿孔分为3种类型，1型（急性）-表现为全身性腹膜炎，2型（亚急性）-穿孔部位液体局限性并伴有胆囊周围脓肿，3型（慢性）-内部（胆汁）肠）或外（胆囊、皮肤）瘘
接受中线剖腹手术，腹腔灌洗和引流管放置。
我们的系列中的死亡率为 6.25%（16 名患者中有 1 名）。1 型 GBP 与死亡率相关，患者死于败血症。平均住院时间为15天，范围为5-25天。
讨论
GBP 可以是外伤性、医源性或特发性的。感染、恶性肿瘤、创伤、药物（如皮质类固醇）和全身性疾病（如糖尿病和动脉粥样硬化性心脏病）是常见的诱发因素。17 GBP 肠热病是一种众所周知的并发症，尽管这种并发症并不常见。30
我们对 176 例 GBP 病例的文献回顾。其中1型75例（42.6%），2-80例（45.5%），3型-21例（11.9%）。在我们的系列中，大多数情况也是 2 型英镑，其次是 1 型和 3 型。这些研究中的男女比例具有可比性，并且没有解释某一性别相对于另一性别的主导地位。正如我们的评论中所见，通常受影响的年龄组是老年组，即 45 岁以上的年龄组。但是，它也出现在年轻人和儿童年龄组中。10 , 16
三种穿孔的机制可以通过以下机制来解释：
当胆囊在底穿孔时，会导致全身性腹膜炎（1 型）。如果穿孔部位在底以外，很容易被大网膜或肠道封闭，病情仍局限于右季肋部，形成腹甲和胆囊周围液体或脓肿（2型）。瘘管是由于胆囊和胃的慢性发炎且紧密粘附的壁的逐渐侵蚀而形成的。其他病因包括消化性溃疡、医源性/外伤和恶性肿瘤。31 , 32
在腹壁脓肿或肝脓肿等非典型表现中，胆囊穿孔和脓肿形成的过程始于结石阻塞胆囊管。它会导致胆囊压力升高，导致眼底区域缺血性坏死和穿孔。炎症被隔离并形成局部胆囊周围脓肿。脓肿可能会消退、穿孔到邻近的内脏或穿透腹壁，导致壁壁肿胀。这一阶段的顶壁脓肿经常被漏诊，患者因脓肿外部破裂而出现胆囊皮瘘。9 , 33
GBP患者通常会出现腹部疼痛、发烧和呕吐等症状。这些特征是不同腹部疾病（胆囊炎、胰腺炎、胆管炎、GBP 等）所共有的；因此，很难立即诊断出这种情况。诊断需要放射学证实，特别是在 II 型和 III 型穿孔的情况下。GBP 的非典型表现，如我们系列中的腹壁脓肿和肝脓肿已在文献5 - 12中报道，由于其不寻常的表现，可能会令临床医生感到困惑。
在北美外科感染学会（SIS）和美国传染病学会（IDSA）发布的指南中，继发性腹膜炎的抗菌治疗应包括对需氧菌和厌氧菌均具有活性的药物或药物组合。34 - 36选择的抗菌药物应同时针对革兰氏阴性菌（例如大肠杆菌）和厌氧菌（例如脆弱拟杆菌）。广谱头孢菌素单一药物治疗，或β-内酰胺/β-内酰胺酶抑制剂组合，或与需氧菌和厌氧菌药物的联合治疗，已被证明可有效治疗社区获得性腹内感染的轻度至严重程度中等。拯救脓毒症运动 (SSC) 建议在发病后的前 6 小时内开始静脉注射抗生素，以降低与严重脓毒症相关的死亡率。
Patel G, Jain A, Kumar RB, Singh N, Karim T, Mishra R. Gallbladder Perforation: A Prospective Study of Its Divergent Appearance and Management. Euroasian J Hepatogastroenterol. 2019 Jan-Jun;9(1):14-19. doi: 10.5005/jp-journals-10018-1289. PMID: 31988861; PMCID: PMC6969324.
是急性胆囊炎胆石症的罕见并发症，发病率和死亡率较高，但没有特定的病理学特征，经常被误诊或晚期诊断。
最常用的是 Niemeier 分类。1934年，他将GBP穿孔分为3种类型，1型（急性）-表现为全身性腹膜炎，2型（亚急性）-穿孔部位液体局限性并伴有胆囊周围脓肿，3型（慢性）-内部（胆汁）肠）或外（胆囊、皮肤）瘘
接受中线剖腹手术，腹腔灌洗和引流管放置。
我们的系列中的死亡率为 6.25%（16 名患者中有 1 名）。1 型 GBP 与死亡率相关，患者死于败血症。平均住院时间为15天，范围为5-25天。
讨论
GBP 可以是外伤性、医源性或特发性的。感染、恶性肿瘤、创伤、药物（如皮质类固醇）和全身性疾病（如糖尿病和动脉粥样硬化性心脏病）是常见的诱发因素。17 GBP 肠热病是一种众所周知的并发症，尽管这种并发症并不常见。30
我们对 176 例 GBP 病例的文献回顾。其中1型75例（42.6%），2-80例（45.5%），3型-21例（11.9%）。在我们的系列中，大多数情况也是 2 型英镑，其次是 1 型和 3 型。这些研究中的男女比例具有可比性，并且没有解释某一性别相对于另一性别的主导地位。正如我们的评论中所见，通常受影响的年龄组是老年组，即 45 岁以上的年龄组。但是，它也出现在年轻人和儿童年龄组中。10 , 16
三种穿孔的机制可以通过以下机制来解释：
当胆囊在底穿孔时，会导致全身性腹膜炎（1 型）。如果穿孔部位在底以外，很容易被大网膜或肠道封闭，病情仍局限于右季肋部，形成腹甲和胆囊周围液体或脓肿（2型）。瘘管是由于胆囊和胃的慢性发炎且紧密粘附的壁的逐渐侵蚀而形成的。其他病因包括消化性溃疡、医源性/外伤和恶性肿瘤。31 , 32
在腹壁脓肿或肝脓肿等非典型表现中，胆囊穿孔和脓肿形成的过程始于结石阻塞胆囊管。它会导致胆囊压力升高，导致眼底区域缺血性坏死和穿孔。炎症被隔离并形成局部胆囊周围脓肿。脓肿可能会消退、穿孔到邻近的内脏或穿透腹壁，导致壁壁肿胀。这一阶段的顶壁脓肿经常被漏诊，患者因脓肿外部破裂而出现胆囊皮瘘。9 , 33
GBP患者通常会出现腹部疼痛、发烧和呕吐等症状。这些特征是不同腹部疾病（胆囊炎、胰腺炎、胆管炎、GBP 等）所共有的；因此，很难立即诊断出这种情况。诊断需要放射学证实，特别是在 II 型和 III 型穿孔的情况下。GBP 的非典型表现，如我们系列中的腹壁脓肿和肝脓肿已在文献5 - 12中报道，由于其不寻常的表现，可能会令临床医生感到困惑。
在北美外科感染学会（SIS）和美国传染病学会（IDSA）发布的指南中，继发性腹膜炎的抗菌治疗应包括对需氧菌和厌氧菌均具有活性的药物或药物组合。34 - 36选择的抗菌药物应同时针对革兰氏阴性菌（例如大肠杆菌）和厌氧菌（例如脆弱拟杆菌）。广谱头孢菌素单一药物治疗，或β-内酰胺/β-内酰胺酶抑制剂组合，或与需氧菌和厌氧菌药物的联合治疗，已被证明可有效治疗社区获得性腹内感染的轻度至严重程度中等。拯救脓毒症运动 (SSC) 建议在发病后的前 6 小时内开始静脉注射抗生素，以降低与严重脓毒症相关的死亡率。
Patel G, Jain A, Kumar RB, Singh N, Karim T, Mishra R. Gallbladder Perforation: A Prospective Study of Its Divergent Appearance and Management. Euroasian J Hepatogastroenterol. 2019 Jan-Jun;9(1):14-19. doi: 10.5005/jp-journals-10018-1289. PMID: 31988861; PMCID: PMC6969324.
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