natgillin/translations-raw huggingface dataset:
For these products, the PRAC considered that the risk can be managed though restriction of use, in the lowest dose that provides sufficient enhancement for diagnostic purposes and through appropriate warning in the product information in order to minimise the potential for accumulation of gadolinium in the brain and other organs and tissues. 
PRAC smatra da se rizikom povezanim s tim lijekovima može upravljati putem ograničenja uporabe, primjenom najmanje doze koja pruža dovoljno poboljšanje u dijagnostičke svrhe i odgovarajućih upozorenja u informacijama o lijeku kako bi se smanjila mogućnost taloženja gadolinija u mozgu, drugim organima i tkivima.
Furthermore, as no specific patient group with less risk of accumulation in the brain or a safe threshold level for retention in the brain could be identified, the restriction of the use of linear GdCAs to certain indications or certain groups of patients was considered not appropriate. 
Štoviše, budući da nije bilo moguće utvrditi skupinu bolesnika s manjim rizikom od taloženja u mozgu ili sigurnu razinu za zadržavanje u mozgu, ograničenje uporabe linearnih GdCA-ova na određene indikacije ili određene skupine bolesnika smatra se neprimjerenim.
• Based on non-clinical and clinical data, both linear and macrocyclic agents have the ability to distribute to the brain. 
• Neklinički i klinički podaci pokazuju da se i linearna i makrociklička sredstva mogu distribuirati u mozgu.
Gadolinium containing products have been stratified by risk category for NSF, and warnings and restrictions on the use of the higher NSF risk products in patients with impaired renal function are included in the product information, including contraindication of the high NSF risk products in patients with severe renal impairment or acute kidney injury (AKI) and a switch to the use of low risk products. 
Upozorenja i ograničenja za primjenu lijekova koji imaju veći rizik od NSF-a u bolesnika s oštećenom bubrežnom funkcijom navedena su u informacijama o lijeku, uključujući kontraindikaciju lijekova s visokim rizikom od NSF-a u bolesnika s teškim oštećenjem bubrega ili akutnom ozljedom bubrega (AKI) te njihovu zamjenu lijekovima s niskim rizikom.
Data appears to suggest that macrocyclic agents are also deposited in the brain but show only a transient increase in Gd and undergo early washout. 
Čini se da podaci pokazuju da se makrociklička sredstva također talože u mozgu, ali razina gadolinija samo se malo povećava i rano se povlači.
Therefore, in view of the evidence regarding accumulation of Gd in brain and the plausible harmful effects, and accumulation of Gd in other tissues and the identified related risk, and considering that less restrictive risk minimisation measures are not feasible or not sufficient to bring the risk of accumulation of gadolinium in the brain and other tissues to an acceptable level, PRAC considered the suspension of the marketing authorisation of intravenous linear GdCAs is the most appropriate measure to mitigate the risks related to these products. 
Stoga, uzimajući u obzir dokaze o taloženju gadolinija u mozgu i mogućim štetnim učincima, taloženju gadolinija u drugim tkivima i povezanom riziku, kao i to da manje stroge mjere za smanjenje rizika nisu provedive ni dovoljne za smanjivanje taloženja gadolinija u mozgu i drugim tkivima na prihvatljivu razinu, PRAC smatra da je obustava odobrenja za stavljanje u promet za intravenske linearne GdCAove najprikladnija mjera za ublažavanje rizika povezanih s tim lijekovima.
• Furthermore, dense deposits in various tissues were detected after GdCA administration by Transmission electron microscopy (TEM), which were regarded as Gd deposits. 
• Štoviše, gusti talog u raznim tkivima primijećen je nakon primjene GdCA-a putem prijenosne elektronske mikroskopije (TEM).
Firstly, PRAC noted that accumulation in the brain is an intrinsic property of intravenous linear GdCAs and therefore, information on brain accumulation in the SmPC will not lead to a reduction of potential risks associated with this accumulation. 
PRAC je prvenstveno istaknuo da je taloženje u mozgu intrinzično svojstvo intravenskih linearnih GdCA sredstava te da navođenje informacija o taloženju u mozgu u sažecima opisa svojstava lijeka neće dovesti do smanjenja mogućih rizika povezanih s tim taloženjem.
Only a transient increase in T1signal intensity and gadolinium concentration (measured by ICP-MS1, thus not distinguishing the molecular form of Gd) was observed with macrocyclic agents. 
Kod makrocikličkih sredstava primijećeno je samo prolazno povećanje intenziteta T1 signala i koncentracija gadolinija (mjereno po ICP-MS-u1 bez utvrđivanja razlike molekularnog oblika gadolinija).
With regards to the consideration of the risk of NSF, whilst PRAC relied on the previous assessment and classification of the risk of NSF across the GdCAs products, PRAC considered that the NSF risk contributes to the safety profile of GdCAs and is taken into account to conclude on the whole safety profile of these products and the subsequent impact on their benefit-risk balance. 
Uzimajući u obzir razmatranje rizika od NSF-a, PRAC se oslonio na prethodnu ocjenu i razvrstavanje rizika od NSF u odnosu na razne lijekove koji sadrže GdCA sredstva te smatra da rizik od NSF-a doprinosi sigurnosnom profilu GdCA-ova te se taj rizik uzima u obzir pri donošenju zaključka o ukupnom sigurnosnom profilu tih lijekova te o utjecaju tog rizika na ukupni omjer koristi/rizika.
For the suspension of intravenous medicinal products containing gadodiamide, gadopentetic acid, and gadoversetamide to be lifted, the marketing authorisation holder(s) shall submit evidence: 
Kako bi se ukinula obustava odobrenja za intravenske lijekove koji sadržavaju gadodiamid, gadopentetičnu kiselinu i gadoversetamid, nositelji odobrenja trebaju podnijeti sljedeće dokaze:
Therefore the CHMP recommends the variation to the terms of the marketing authorisations for medicinal products containing intravenous gadobutrol, gadoteric acid, gadoteridol, gadoxetic acid, intravenous gadobenic acid in the indication of liver imaging, intra-articular gadoteric acid and intraarticular gadopentetic acid. 
Stoga CHMP preporučuje izmjenu uvjeta za odobrenje za stavljanje lijeka u promet za lijekove koji sadržavaju intravenski gadobutrol, gadoteričnu kiselinu, gadoteridol, gadoksetičnu kiselinu, intravensku gadobensku kiselinu za indikaciju snimanja jetre, intraartikularnu gadoteričnu kiselinu i intraartikularnu gadopentetičnu kiselinu.
Accumulation in the brain 
Taloženje u mozgu
• High Gd levels with high inter-individual variability were detected in saline-treated controls. 
• Visoke razine gadolinija s visokom pojedinačnom promjenjivosti primijećene su u pretragama sa fiziološkom otopinom.
The CHMP also concluded that there are practical difficulties for an effective restriction of the number of doses administered during the lifetime of a patient. 
CHMP je također zaključio da postoje praktične poteškoće za djelotvorno ograničavanje broja doza koji bolesnik primi tijekom cijelog života.
Although no adverse neurological effects have yet been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited. 
Iako još nije pokazano da taloženje gadolinija u mozgu ima štetne neurološke učinke, podaci o dugoročnoj sigurnosti ograničeni su.
Taking into account the evidence of accumulation of GdCAs in the brain, the fact that linear compounds have been detected in the brain to a much higher amount than the macrocyclic compounds and that they persist in the brain for a longer period, and considering the toxicity of Gd shown in non-clinical studies, the serious concerns about potential neurological harm, deposition in other tissues and its potential risks, and the identified risks associated with the use of linear GdCAs (including the risk of NSF and the gadolinium-associated plaques) and in view of the whole safety profile of these agents, PRAC maintained its conclusion that that the benefit in enhancement of MR images of intravenous linear agents does not outweigh the known and potential risks of these products. 
Uzimajući u obzir dokaze o taloženju GdCA-ova u mozgu, činjenicu da su otkriveni linearni spojevi u mozgu u mnogo većoj mjeri nego nakon primjene makrocikličkih spojeva, da se u mozgu zadržavaju duže vremensko razdoblje, kao i toksičnost gadolinija pokazanu u nekliničkim ispitivanjima, ozbiljne zabrinutosti u pogledu moguće štete za neurološki sustav, taloženje u drugim tkivima i moguće rizike od taloženja, kao i već utvrđene rizike povezane s uporabom linearnih GdCA-ova (uključujući značajan rizik od NSF-a i plakova povezanih s gadolinijem), kao i ukupni sigurnosni profil tih sredstava, PRAC donosi isti zaključak da korist intravenskih linearnih sredstava u pogledu poboljšavanja snimki magnetske rezonancije ne nadmašuje poznate i moguće rizike tih lijekova.
• In addition to NSF, there is also evidence that other harmful outcomes are associated with exposure to linear GdCAs, in particular gadolinium-associated skin plaques. 
• Postoje dokazi i o tome da je izlaganje linearnim GdCA-ovima povezano ne samo s NSF-om nego i s drugim štetnim ishodima, a posebno kožnim plakovima koje uzrokuje gadolinij.
Deposition of gadolinium in the brain 
Taloženje gadolinija u mozgu
• Based on non-clinical data, both linear and macrocyclic agents have the ability to distribute to the brain. 
• Neklinički podaci pokazuju da se i linearna i makrociklička sredstva mogu distribuirati u mozgu.
The PRAC also concluded that there are practical difficulties for an effective restriction of the number of doses administered during the lifetime of a patient. 
PRAC je također zaključio da postoje praktične poteškoće za djelotvorno ograničavanje broja doza koje bolesnik primi tijekom cijelog života.
The ground concerning the skin plaques “in addition to NSF, there is also evidence that other harmful outcomes are associated with exposure to linear GdCAs, in particular gadolinium-associated skin plaques” is based on a limited number of cases, and therefore CHMP did not consider it relevant as ground for the suspension of some of the IV linear GdCAs. 
Razlog koji se odnosi na kožne plakove „postoje dokazi i o tome da je izlaganje linearnim GdCA-ovima povezano ne samo s NSF-om nego i s drugim štetnim ishodima, a posebno kožnim plakovima koje uzrokuje gadolinij“ temelji se na ograničenom broju slučajeva.
• The PRAC considered that the risk related to linear intravenous GdCAs gadobenic acid (in all indications besides liver imaging), gadodiamide, gadopentetic acid, and gadoversetamide, taking into account the whole safety profile, including the additional potential risk of harm from brain and other tissues accumulation outweighs the benefits. 
• PRAC smatra da rizik povezan s linearnim intravenskim GdCA-ovima, gadobenskom kiselinom (za sve indikacije, osim za snimanje jetre), gadodiamidom, gadopentetičnom kiselinom i gadoversetamidom, uzimajući u obzir cijeli sigurnosni profil, uključujući mogući rizik od oštećenja uzrokovanih taloženjem u mozgu i drugim tkivima, nadmašuje koristi.
Therefore, it can be concluded that renal impairment is not a requirement for Gd deposition, but it may however increase the amount of Gd deposited in the brain. 
Stoga se može zaključiti da oštećenje bubrega nije preduvjet za taloženje gadolinija, ali može povećati količinu gadolinija koji se taloži na mozgu.
The CHMP concluded that the risk of NSF is different for the different gadolinium-containing contrast agents, which lead to the categorisation of GdCAs into three risk groups for NSF (high risk, medium risk and low risk). 
Stoga se GdCA-ovi kategoriziraju u tri rizične skupine u odnosu na NSF (visokorizičnu, srednjerizičnu i niskorizičnu).
• The CHMP considered that the risk related to linear intravenous GdCAs gadobenic acid (in all indications besides liver imaging), gadodiamide, gadopentetic acid, and gadoversetamide, taking into account the whole safety profile, including the additional potential risk of harm from brain and other tissues accumulation outweighs the benefits. 
• CHMP smatra da rizik povezan s linearnim intravenskim GdCA-ovima, gadobenskom kiselinom (za sve indikacije, osim za snimanje jetre), gadodiamidom, gadopentetičnom kiselinom i gadoversetamidom, uzimajući u obzir cijeli sigurnosni profil, uključujući mogući rizik od oštećenja uzrokovanih taloženjem u mozgu i drugim tkivima, nadmašuje koristi.
Indeed, PRAC considered the results of two intra-individual, crossover comparisons of 0.1 mmol/kg body weight with Multihance vs 0.1 mmol/kg body weight of two active comparators (gadopentetate dimeglumine and gadodiamide), in patients with known or suspected brain or spine disease undergoing MRI of the central nervous system (CNS) (MH-109, MH-130) and concluded that the studies were using a blinded comparison of MRI images obtained with two GdCAs side by side and have produced results favouring Multihance on the basis of brighter appearance of the images, but not reflecting any difference in the diagnostic information available or the impact on diagnostic thinking, patient management or clinical outcome. 
PRAC je razmotrio rezultate dviju pojedinačnih, recipročnih usporedbi, odnosno 0,1 mmol/kg tjelesne mase za Multihance u usporedbi s 0,1 mmol/kg tjelesne mase dvaju aktivnih sredstava za usporedbu (gadopentetat dimeglumin i gadodiamid) u bolesnika s poznatom ili mogućom bolesti mozga ili kralježnice koji se podvrgavaju magnetnoj rezonanciji središnjeg živčanog sustava (CNS) (MH-109, MH-130).
Gadobenic acid undergoes hepatic uptake. 
Gadobenska kiselina unosi se u jetru.
• variation to the terms of the marketing authorisation for the intraarticular linear agent gadopentetic acid (Magnevist), and the intravenous linear agents gadoxetic acid (Primovist) and gadobenic acid (Multihance) with changes to SmPC sections 4.1, 4.2, 4.4 and 5.2, including removal of indications, 
(Primovist) te gadobensku kiselinu (Multihance), uz izmjene odjeljaka u sažetku opisa svojstava lijeka 4.1., 4.2., 4.4. i 5.2., uključujući izbacivanje indikacija,
Renal impairment is also known to increase the long term retention of Gd in rats in line with the propensity of GdCAs to release Gd in vivo. 
Poznato je da oštećenje bubrega povećava dugoročno zadržavanje gadolinija u štakora u skladu s vjerojatnošću kojom GdCA-ovi ispuštaju gadolinij in vivo.
The benefit-risk balance of medicinal products containing intravenous gadobutrol, gadoteric acid, gadoteridol, gadoxetic acid, intravenous gadobenic acid in the indication of liver imaging, intra-articular gadoteric acid and intra-articular gadopentetic acid is favourable subject to agreed changes to the product information: 
Omjer koristi/rizika lijekova koji sadržavaju intravenski gadobutrol, gadoteričnu kiselinu, gadoteridol, gadoksetičnu kiselinu, intravensku gadobensku kiselinu za indikaciju snimanja jetre, intraartikularnu gadoteričnu kiselinu i intraartikularnu gadopentetičnu kiselinu povoljan je i podliježe dogovorenim izmjenama u informacijama o lijeku:
• variation to the terms of the marketing authorisation for the macrocyclic agents (gadoteridol (Prohance), gadobutrol (Gadovist), gadoteric acid (Dotarem and Artirem)) with changes to SmPC sections 4.1 and 4.2. 
(Prohance), gadobutrol (Gadovist), gadoteričnu kiselinu (Dotarem i Artirem)) uz izmjene odjeljaka u sažetku opisa svojstava lijeka 4.1. i 4.2.
• Gadolinium accumulation has also been reported in a range of other tissues including the liver, kidney, muscle, skin and bone in non-clinical and clinical studies. 
• U nekliničkim i kliničkim ispitivanjima zabilježeno je taloženje gadolinija i u nizu drugih tkiva, uključujući jetru, bubrege, mišiće, kožu i kosti.
They are administered at low concentrations, approximately 200-fold lower than the intravenous use GdCA products, and the potential for patients to receive large numbers of repeated exposures is less for the MR arthrography indication than for the indications for the intravenous product. 
Potencijal bolesnika za primanje većeg broja ponovljenih izlaganja manji je za indikaciju magnetske artrografije nego za indikacije za intravensku primjenu proizvoda.
• The PRAC took into account that the linear intravenous agents, Multihance (gadobenic acid) and Primovist (gadoxetic acid), undergo hepatic uptake, and therefore have clinical utility for imaging poorly vascularised hepatic lesions, especially in the delayed phase imaging, that cannot be adequately studied with agents without hepatic uptake and thus allowing early diagnosis of potentially life threatening diseases. 
• PRAC je u obzir uzeo da se linearna intravenska sredstva, Multihance (gadobenska kiselina) i Primovist (gadoksetična kiselina) unose u jetru te su stoga klinički korisna za snimanje lezija u jetri sa slabom vaskularizacijom, posebno u snimanju u odgođenoj fazi.
The benefit of GdCAs has been demonstrated based on their ability to improve the quality of imaging for MRIs compared to unenhanced MRI scans by supporting the diagnostic performance of such scans in the detection of disease, prognosis and patient management in order to achieve a particular clinical outcome. 
GdCA-ovi poboljšavaju dijagnostičku izvedbu takvih snimki i olakšavaju otkrivanje bolesti, određivanje prognoze i upravljanje bolesnikom kako bi se ostvario određeni klinički ishod.
Therefore, the CHMP considered that the benefits of gadobenic acid and gadoxetic acid outweigh the risks related to these products in the context of liver imaging. 
Stoga CHMP smatra da koristi gadobenske kiseline i gadoksetične kiseline nadmašuju s njima povezane rizike u kontekstu snimanja jetre.
In addition, toxicities have been observed with GdCAs in other organs, such as kidney (leading to NSF) and skin (leading to skin plaques), which are considered to be related to Gadolinium released from the chelate. 
Nadalje, toksičnost je primijećena kod GdCA-ova u drugim organima, kao što su bubrezi (uzrokuje NSF) i koža (uzrokuje oštećenja kože).
Benefits 
Koristi
Therefore, PRAC considered that the benefits of gadobenic acid and gadoxetic acid outweigh their risks in the context of delayed phase liver imaging. 
Stoga PRAC smatra da koristi gadobenske kiseline i gadoksetične kiseline nadmašuju s njima povezane rizike u kontekstu snimanja jetre u odgođenoj fazi.
Final benefit-risk balance 
Ukupan omjer koristi i rizika
Organ-specific indication for Omniscan 
Indikacija za Omniscan za određene organe
• The CHMP took into account that the linear intravenous agents, Multihance (gadobenic acid) and Primovist (gadoxetic acid), undergo hepatic uptake, and therefore have clinical utility for imaging poorly vascularised hepatic lesions, especially in the delayed phase imaging, that cannot be adequately studied with agents without hepatic uptake and thus allowing early diagnosis of potentially life threatening diseases. 
• CHMP je u obzir uzeo da se linearna intravenska sredstva Multihance (gadobenska kiselina) i Primovist (gadoksetična kiselina) unose u jetru te su stoga klinički korisna za snimanje lezija u jetri sa slabom vaskularizacijom, posebno u snimanju u odgođenoj fazi.
Therefore, the PRAC considered that the benefits of gadobenic acid and gadoxetic acid outweigh the risks related to these products in the context of liver imaging. 
Stoga PRAC smatra da koristi gadobenske kiseline i gadoksetične kiseline nadmašuju s njima povezane rizike u kontekstu snimanja jetre.
• In relation to the Magnevist (gadopentetic acid) for intra-articular injection, in view of the low dose, the limited potential for repeated exposure for patients and the absence of evidence of brain accumulation, PRAC considered that the benefits of this product outweigh its risks. 
• U pogledu Magnevista (gadopentetična kiselina) za intraartikularnu injekciju, uzimajući u obzir nisku dozu, ograničenu mogućnost za ponovno izlaganje bolesnika i manjak dokaza o taloženju u mozgu,
This was discussed with clinical experts within an ad hoc expert group meeting that confirmed a possible association but this has not yet been demonstrated. 
Klinički stručnjaci raspravili su o ovoj temi na ad hoc sastanku stručne skupine.
• Although no adverse neurological effects, such as cognitive or movement disorders, have yet been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited. 
• Iako još nije dokazano da taloženje gadolinija u mozgu ima štetne neurološke učinke, na primjer kognitivne poremećaje ili poremećaje kretanja, podaci o dugoročnoj sigurnosti ograničeni su.
Harmful effects and potential interaction with disease processes are possible in view of data supporting dechelation of linear agents in vivo and the known toxicity of unchelated gadolinium based on non-clinical data”. 
Štetni učinci i moguća interakcija s bolestima mogući su u pogledu podataka koji ukazuju na dekelaciju linearnih sredstava in vivo i poznatu toksičnost nekeliranog gadolinija na temelju nekliničkih podataka“.
The MAHs provided several proposals for risk minimization measures with regards the accumulation and retention of GdCA in the brain of patients exposed to these agents during diagnostic procedures: 
GdCA sredstava u mozgu bolesnika koji se izlažu tim sredstvima tijekom dijagnostičkih postupaka:
Toxicity of accumulation of Gd in the brain 
Toksičnost taloženja gadolinija u mozgu
Harmful effects and potential interaction with disease processes are plausible in view of stability data suggesting dechelation of linear agents in vivo and the known toxicity of unchelated gadolinium. 
Štetni učinci i moguća interakcija s bolestima vjerojatni su u pogledu podataka o stabilnosti koji ukazuju na dekeliranje linearnih sredstava in vivo i poznatu toksičnost nekeliranog gadolinija.
Harmful effects and potential interaction with disease processes are possible in view of data supporting dechelation of linear agents in vivo and the known toxicity of unchelated gadolinium based on non-clinical data. 
Štetni učinci i moguća interakcija s bolestima mogući su u pogledu podataka koji ukazuju na dekeliranje linearnih sredstava in vivo i poznatu toksičnost nekeliranog gadolinija na temelju nekliničkih podataka.
However, they described the TEM finding of electrondense lumps in the tissues of ProHance-treated animals which at first were assumed to be Gd deposits, obviously because they looked like them. 
Međutim, opisali su TEM otkrića elektronski gustih kvržica u tkivima životinja liječenih lijekom ProHance.
The CHMP, as a consequence, considers that the benefit-risk balance of medicinal products containing intravenous gadobutrol, gadoteric acid, gadoteridol, gadoxetic acid, intravenous gadobenic acid in the indication of liver imaging, intra-articular gadoteric acid and intra-articular gadopentetic acid remains favourable subject to amendments to the product information. 
Omjer koristi i rizika lijekova koji sadržavaju intravenski gadobutrol, gadoteričnu kiselinu, gadoteridol, gadoksetičnu kiselinu, intravensku gadobensku kiselinu za indikaciju snimanja jetre, intraartikularnu gadoteričnu kiselinu i intraartikularnu gadopentetičnu kiselinu povoljan je i podliježe dogovorenim izmjenama u informacijama o lijeku:
These products undergo hepatic uptake, and have therefore a clinical utility for imaging poorly vascularised hepatic lesions, especially in the delayed phase imaging, that cannot be adequately studied with agents without hepatic uptake and thus allowing early diagnosis of potentially life threatening diseases. 
Ta se korist ne može ispitati na odgovarajući način za sredstva koja se ne unose u jetru i stoga omogućuju ranu dijagnozu mogućih smrtonosnih bolesti.
Harmful effects and potential interaction with disease processes are plausible in view of data supporting dechelation of linear agents in vivo and the known toxicity of unchelated gadolinium. 
Štetni učinci i moguća interakcija s bolestima vjerojatni su u pogledu podataka koji ukazuju na dekeliranje linearnih sredstava in vivo i poznatu toksičnost nekeliranog gadolinija.
Glyxambi is used in the following groups: 
Glyxambi se primjenjuje u sljedećim skupinama: