natgillin/translations-raw huggingface dataset:
Data in post mortem tissue samples have shown that the highest concentration of gadolinium in the brain was observed in patients that had several exposures to gadodiamide, suggesting that number of doses received had an impact on the deposition of gadolinium. 
Podaci u post mortem uzorcima tkiva pokazuju da je najveća koncentracija gadolinija u mozgu primijećena u bolesnika koji su nekoliko puta bili izloženi gadodiamidu, što dokazuje da je broj primljenih doza utjecao na taloženje gadolinija.
Feasibility of clinical studies 
Izvedivost kliničkih ispitivanja
Furthermore the CHMP took the opportunity to clarify that toxicities of non-chelated gadolinium discussed in the non-clinical section of the scientific grounds above have been observed with GdCAs in skin and other tissues (leading to NSF and skin plaques), which are considered to be related to Gadolinium released from the chelate. 
Štoviše, CHMP iskoristio je priliku kako bi pojasnio da je toksičnost nekeliranog gadolinija o kojoj se raspravljalo u prethodno navedenom nekliničkom odjeljku znanstvenih obrazloženja primijećena nakon primjene GdCA-ova na koži i drugim tkivima (uzrokuje NSF i kožne plakove) te se smatra da je povezana s gadolinijem koji se ispušta iz kelata.
Since the finalisation of the referral, several studies in animals and in humans have been published showing accumulation of gadolinium following administration of GdCAs in tissues such as liver, kidney, muscle, skin and bone. 
Od dovršetka upućivanja objavljeno je nekoliko ispitivanja na ljudima i životinjama koji pokazuju taloženje gadolinija nakon primjene GdCA-ova u tkivima kao što su jetra, bubrezi, mišići, koža i kosti.
The evidence strongly suggests a correlation between the potential for release of gadolinium from the ligand and the extent of retention in these tissues and organs. 
Dokazi jasno ukazuju na povezanost između mogućeg ispuštanja gadolinija iz liganda i razmjera zadržavanja u tim tkivima i organima.
Intra-articular products containing gadopentetic acid and gadoteric acid are administered at very low doses and present a low risk of tissue accumulation. 
Intraartikularni lijekovi koji sadrže gadopentetičnu kiselinu i gadoteričnu kiselinu primjenjuju se u vrlo malim dozama i predstavljaju nizak rizik od taloženja u tkivu.
Furthermore, CHMP agreed that a communication to healthcare professionals through a joint DHPC should be sent by the MAHs, to which the MAHs agreed. 
Štoviše, CHMP slaže se s tim da nositelji odobrenja za stavljanje u promet trebaju poslati sporazumnu obavijest zdravstvenim stručnjacima putem zajedničkog izravnog pisma zdravstvenim radnicima (DHPC-a).
Repetitive administration of gadodiamide in rats with renal failure was associated with an increase in the T1 hypersignal in the deep cerebellar nuclei relative to controls with normal renal function. 
Ponovljena primjena gadodiamida u štakora s oštećenjem bubrega povezana je s povećanjem T1 hipersignala u dubokom cerebralnom nukleusu u odnosu na kontrole štakora s normalnom bubrežnom funkcijom.
With regards to the claim that gadodiamide (Omniscan) has a unique indication in myocardial perfusion imaging PRAC considered that the whole body MRI indication encompasses imaging of the heart, including myocardial perfusion imaging. 
U pogledu tvrdnje da gadodiamid (Omniscan) ima jedinstvenu indikaciju za snimanje perfuzije miokarda, PRAC smatra da indikacija MRI-ja cijelog tijela obuhvaća snimanje srca, uključujući snimanje perfuzije miokarda.
However, these data should be considered in the context of the non-clinical studies showing higher levels of gadolinium in brain tissue after exposure to linear GdCAs, compared with exposure to macrocyclic GdCAs. 
Međutim, ti bi se podaci trebali razmotriti u kontekstu nekliničkih ispitivanja koja pokazuju veće razine gadolinija u moždanom tkivu nakon izlaganja linearnim GdCA-ovima u usporedbi s izloženosti makrocikličkim GdCA-ovima.
Population-specific indication for Multihance 
Indikacija za Multihance za određenu skupinu bolesnika
The brain soluble fractions from animals receiving linear agents contained a proportion of macromolecules; gadolinium-bound macromolecules were not detected in the brain of animals that received macrocyclic agents. 
Topivi djelići u mozgu životinja koje su primale linearna sredstva sadržavali su udio makromolekula; makromolekule vezane za gadolinij nisu pronađene u mozgu životinja koje su primale makrociklička sredstva.
Therefore the benefit of gadoxetic acid outweighs its risk. 
Stoga koristi gadoksetične kiseline nadmašuju rizike.
• Gadolinium has been measured in the brain, both indirectly by studies showing signal intensity increases, and directly by studies measuring gadolinium concentrations with mass spectrometry, including methods that allow localisation in the brain (LA-ICP-MS) and separation of Gd species (GPC-MS). 
• Gadolinij je izravno izmjeren u mozgu u ispitivanjima koje pokazuju povećanje u intenzitetu signala, kao i u ispitivanjima u kojima se mjere koncentracije gadolinija putem masene spektrometrije, uključujući metode koje omogućuju određivanje položaja u mozgu (LA-ICP-MS) i razdvajanje vrsta gadolinija (GPC-MS).
The PRAC also noted that in contrast, for NSF a specific patient group (renal insufficiency and patients in the perioperative liver transplantation period) could be identified, and avoidance of use in these populations appears to have minimised the risk of NSF. 
PRAC je utvrdio i da je, suprotno prethodno navedenom, u pogledu NSF-a moguće odrediti posebnu skupinu bolesnika (bolesnici s bubrežnom insuficijencijom i bolesnici u perioperativnom razdoblju za transplantaciju jetre) te se čini da je izbjegavanje uporabe u tih bolesnika smanjilo rizik od NSF-a.
• or that the product (potentially modified or not) does not undergo significant dechelation and does not lead to retention of gadolinium in tissues, including the brain in humans. 
• ili o tome da lijek (potencijalno izmijenjen ili ne) ne prolazi značajno dekeliranje i ne uzrokuje zadržavanje gadolinija u tkivima, uključujući ljudski mozak.
For liver imaging, some GdCAs allow the possibility of a delayed phase imaging. 
Za snimanje jetre neki GdCA-ovi omogućuju snimanje u odgođenoj fazi.
However, they did not favour the suspension of linear agents which could be preferred by some radiologists for their technical characteristics in some conditions (e.g., breast or brain imaging), especially in conditions that do not require frequent imaging procedures, or which could be used as “second line” agents. 
Međutim, ta stručna skupina ne podržava obustavu linearnih sredstava jer bi ih neki radiolozi zbog njihovih tehničkih karakteristika željeli koristiti za neke slučajeve (npr. snimanje grudi ili mozga), posebno ako se snimanje ne treba često provoditi ili bi koristili ta sredstva kao „drugu mogućnost”.
With regards to the condition for lifting the suspension the MAH shall submit evidence “that the product (potentially modified or not) does not undergo significant dechelation and does not lead to retention of gadolinium in tissues, including the brain in humans”, CHMP agreed in general with the proposal, however considered it necessary clarifying the meaning of this condition to avoid misunderstandings. 
U pogledu uvjeta za ukidanje obustave koji se odnosi na dokaze koje trebaju dostaviti nositelji odobrenja za stavljanje lijeka u promet „da lijek (potencijalno izmijenjen ili ne) ne prolazi značajno dekeliranje i ne uzrokuje zadržavanje gadolinija u tkivima, uključujući ljudski mozak“, CHMP se općenito slaže s prijedlogom, međutim smatra da je potrebno obrazložiti značenje tog uvjeta kako bi se izbjegli nesporazumi.
In view of the above, and the claim on the lack of clinical evidence of neurotoxicity due to deposited gadolinium, PRAC considered that while the clinical consequences of gadolinium retention in the brain are currently unknown or remain unclear, absent or limited information from case reports cannot be taken as evidence that such toxicity does not occur. 
Uzimajući u obzir prethodno navedeno, kao i tvrdnju o manjku kliničkih dokaza o neurotoksičnosti uzrokovanoj taloženjem gadolinija, PRAC smatra da, iako su kliničke posljedice zadržavanja gadolinija u mozgu trenutačno nepoznate ili nejasne, nepostojeći ili ograničeni podaci iz prijavljenih slučaja ne mogu biti dokazi o nepostojanju toksičnosti.
The precise molecular forms of the soluble macromolecular bound Gd are not known but it is plausible that the macromolecules are bound to a dechelated Gd3+ ion. 
Precizni molekularni oblici topivog gadolinija koji se veže za makromolekule nisu poznati, ali vjerojatno se makromolekule vežu za nekelacijski gadolinij3+ ion.
In view of the very low potential for retention of gadolinium in tissues, their stability and low risk of dechelation, PRAC maintained its recommendation that the benefits of macrocyclic agents outweigh their risks. 
Uzimajući u obzir da postoji vrlo mala mogućnost za zadržavanje gadolinija u tkivima, njihovu stabilnost i nizak rizik od dekeliranja, PRAC stoji pri svojoj preporuci da koristi makrocikličkih sredstava nadmašuju s njima povezane rizike.
Toxicity of GdCAs has primarily been attributed to the dissociation of Gd from the chelated complexes. 
Toksičnost GdCA sredstava prvenstveno se pripisuje razdvajanju gadolinija iz keliranih kompleksa.
According to the current knowledge about gadolinium deposition in the brain, linear compounds have been detected in the brain at a higher magnitude than the macrocyclic compounds and they appear to be stored there in a form that does not allow an early washout. 
Na temelju trenutačnog znanja o taloženju gadolinija u mozgu, pronađeni su linearni spojevi u mozgu u većoj količini od makrocikličkih spojeva te se čini da se pohranjuju u obliku koji ne dopušta rano ispiranje.
PRAC considered the detailed grounds as submitted by the MAHs within this re-examination procedure and the scientific data underlying these grounds. 
PRAC je razmotrio detaljne razloge koje su podnijeli nositelji odobrenja za stavljanje u promet u okviru ovog postupka ponovne ocjene te znanstvene podatke koji potkrepljuju te razloge.
PRAC considered potential clinical studies to be conducted in order to fully address the serious concerns of plausible neurological effects. 
PRAC razmatra provedbu kliničkih ispitivanja kako bi se u potpunosti riješile zabrinutosti u pogledu vjerojatnih neuroloških učinaka.
• or that the product (potentially modified or not) does not undergo significant dechelation and does not lead to retention of gadolinium in tissues. 
• ili o tome da lijek (izmijenjen ili ne) ne prolazi značajnu dekelaciju i ne uzrokuje zadržavanje gadolinija u tkivima.
In view of the claim regarding the cardiac indication of Omniscan, the PRAC highlighted that the primary goal of cardiac perfusion imaging is the detection of myocardial ischemia in patients with suspected coronary artery disease or cardiomyopathy. 
Uzimajući u obzir tvrdnju u pogledu kardiološke indikacije za Omniscan, PRAC je naglasio da je primarni cilj snimanja srčane perfuzije otkrivanje ishemije miokarda u bolesnika kod koji se sumnja na koronarnu bolest arterija ili kardiomiopatiju.
The PRAC considered all the available data related to the safety and efficacy to the medicinal products containing gadodiamide, gadopentetic acid, gadobenic acid, gadoxetic acid, gadoteridol, gadobutrol, gadoteric acid and gadoversetamide within the procedure under Article 31 of Directive 2001/83/EC. 
PRAC je u obzir uzeo sve dostupne podatke povezane sa sigurnošću i djelotvornošću lijekova koji sadržavaju gadodiamid, gadopentetičnu kiselinu, gadobensku kiselinu, gadoksetičnu kiselinu, gadoteridol, gadobutrol, gadoteričnu kiselinu i gadoversetamid u okviru postupka na temelju članka 31. Direktive 2001/83/EZ.
Such studies are considered unlikely to be feasible in view of the heterogeneity of the patient population that undergoes MRI. 
Smatra se da takva ispitivanja neće biti provediva u pogledu heterogenosti populacije bolesnika koji se podvrgavaju magnetnoj rezonanciji.
Gadolinium-associated plaques with sclerotic bodies on histology have been reported with some gadolinium-containing contrast agents in patients who do not otherwise have symptoms or signs of nephrogenic systemic fibrosis. 
Prijavljeni su plakovi povezani s gadolinijem sa skleroznim tijelima na histologiji nakon primjene kontrastnih sredstava koji sadrže gadolinij u bolesnika koji nemaju drugih simptoma ili znakova nefrogene sistemske fibroze.
Indeed there are two phases of liver MRI enhancement with GdCAs: 
Postoje dvije faze poboljšanja snimanja jetre magnetskom rezonancijom pomoću GdCA-ova:
Therefore, pursuant to Article 116 of Directive 2001/83/EC, the CHMP recommends the suspension of the marketing authorisations for intravenous medicinal products containing gadodiamide, gadopentetic acid, and gadoversetamide. 
Direktive 2001/83/EZ, CHMP preporučuje obustavu odobrenja za stavljanje lijeka u promet za intravenske lijekove koji sadržavaju gadodiamid, gadopentetičnu kiselinu i gadoversetamid.
Another study showed that at one year, Gd levels in the brain following administration of gadoteric acid, a macrocyclic agent, are over 30 fold lower compared to gadodiamide (linear). 
Drugo ispitivanje pokazalo je da su razine gadolinija u mozgu nakon jedne godine od primjene gadoterične kiseline, makrocikličkog sredstva, za više od 30 jedinica manje u usporedbi s gadodiamidom (linearno sredstvo).
An in vitro study in rat neurons reported gadolinium-induced cytotoxicity via oxidative injury. 
In vitro ispitivanje na neuronima štakora pokazalo je citotoksičnost uzrokovanu gadolinijem putem oksidacijske ozljede.
PRAC noted that gadoxetic acid has only the liver imaging indication. 
PRAC je istaknuo da gadoksetična kiselina ima samo indikaciju za snimanje jetre.
Taking into account the extensive exposure and the absence of clinical or non-clinical adverse outcomes of gadolinium accumulation in the brain, CHMP considered that such harmful effects and potential interaction with disease processes are “possible” rather than “plausible”, as the latter would imply a stronger potential for harm; in this sense, “yet” was also removed. 
Uzimajući u obzir široki razmjer izlaganja i manjak kliničkih i nekliničkih podataka o štetnim nuspojavama uzrokovanih taloženjem gadolinija u mozgu, CHMP smatra da su takvi štetni učinci i moguća interakcija s bolestima „mogući”, a ne „vjerojatni” jer potonji izraz ukazuje na veću mogućnost štetnih nuspojava; u tom smislu uklonjena je i riječ „još”.
Furthermore, recent publications have shown that gadolinium also accumulates in the brain. 
Štoviše, nedavne objave ukazuju na to da se gadolinij taloži i u mozgu.
Whereas 
Na taj način
Thus, rather weak binding of linear chelators to Gd becomes obvious in various experiments (including Port et al 2009, Sieber et al 2008), and this makes it unlikely that the complex is fully stable in vivo. 
Stoga slabo vezanje linearnih kelatora za gadolinij postaje očito u raznim eksperimentima (uključujući Port i dr., 2009.; Sieber i dr., 2008.).
Adverse effects might be delayed and might be subtle, including effect on fine motor skills or cognitive impairment, particularly in those with ongoing neurological disease. 
Štetni učinci mogu biti odgođeni i suptilni, uključujući učinak na fine motoričke vještine ili kognitivno oštećenje, posebno u bolesnika s trajnom neurološkom bolesti.
With regards to the claim of a lower risk of cardiovascular adverse events for Multihance, PRAC considered that nonclinical data as well as available clinical data do not indicate a difference in cardiovascular risk (inducing QT prolongation) within the delayed phase liver imaging agents. 
U pogledu tvrdnje da Multihance ima manji rizik od štetnih kardiovaskularnih događaja, PRAC smatra da neklinički podaci te dostupni klinički podaci ne dokazuju razliku u pogledu kardiovaskularnih rizika (uključujući produljenje QT intervala) pri primjeni sredstava za snimanje jetre u odgođenoj fazi.
GdCAs can be differentiated by their structure: linear (gadodiamide, gadopentetic acid, gadobenic acid, gadoxetic acid, gadoversetamide) or macrocyclic (gadoteridol, gadobutrol, gadoteric acid), and by the overall charge on the complex formed (ionic or non-ionic). 
GdCA-ovi razlikuju se prema svojoj strukturi: linearna (gadodiamid, gadopentetična kiselina, gadobenska kiselina, gadoksetična kiselina, gadoversetamid) ili makrociklička (gadoteridol, gadobutrol, gadoterična kiselina) te prema ukupnom naponu formiranog kompleksa (ionskog ili neionskog).
There are practical difficulties in clinical daily life for implementing an effective restriction of the number of doses administered during the lifetime of a patient. 
Postoje praktične poteškoće u svakodnevnom kliničkom životu koje sprječavaju primjenu djelotvornog ograničenja broja doza koje se primjenjuju tijekom cijelog života bolesnika.
There have been more recent MRI studies that have documented signal intensity increases in the brain in association with macrocyclic GdCAs, suggesting that these agents may also deposit gadolinium in the brain. 
Postoje i nedavna MRI ispitivanja koja bilježe povećanje intenziteta signala u mozgu povezano s makrocikličkim GdCA-ovima, što ukazuje na to da i ta sredstva mogu taložiti gadolinij u mozgu.
With regards to non-clinical studies, unchelated gadolinium in the form of gadolinium chloride has been shown to be toxic with effects including cellular necrosis, fibrosis, and lesions related to mineral deposition (Spencer et al. 1997; Rees et al. 1997), and an in vitro study in rat neurons reported gadolinium-induced cytotoxicity via oxidative injury (Xia et al. 2011). 
Neklinička ispitivanja pokazala su da je nekelirani gadolinij u obliku gadolinijeva klorida toksičan te ima učinke kao što su stanična nekroza, fibroza i lezije povezane s taloženjem minerala (Spencer i dr. 1997.; Rees i dr. 1997.), a in vitro ispitivanje na štakorima pokazalo je citotoksičnost uzrokovanu gadolinijem putem oksidacijske ozljede (Xia i dr. 2011.).
Another study showed that administration of the linear GdCAs gadodiamide and gadobenic acid directly into the cerebrospinal fluid (CSF) resulted in increased signal intensity in the DCN in rats up to 5 weeks after administration. 
Drugo ispitivanje pokazalo je da primjena linearnih GdCA-ova, gadodiamida i gadobenske kiseline, izravno u cerebrospinalnu tekućinu (CSF) dovodi do povećanja intenziteta signala u DCN-u u štakora 5
1 ICP-MS: Inductively coupled plasma mass spectrometry 
1 ICP-MS: masena spektrometrija s induktivno spregnutom plazmom tjedana nakon primjene.
The increased potential to release gadolinium in the brain would be expected with the linear agents, which have a lower kinetic and thermodynamic stability and are thus more prone to release gadolinium in the tissue environment. 
Pri primjeni linearnih sredstava očekuje se veća mogućnost otpuštanja gadolinija u mozak jer imaju manju kinetičku i termodinamičku stabilnost te stoga postoji veća vjerojatnost da će otpustiti gadolinij u okolno tkivo.
In view of a potential difference in the frequency of hypersensitivity reactions, PRAC pointed out that these are known infrequent reactions for all GdCAs. 
Uzimajući u obzir moguću razliku u učestalosti reakcija preosjetljivosti, PRAC je istaknuo da su poznate neučestale reakcije za sva GdCA sredstva.
The CHMP further considered the statement addressing the potential harm associated with the gadolinium accumulation in the brain: “although no adverse neurological effects, such as cognitive or movement disorders, have been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited. 
CHMP je razmotrio i izjavu koja se odnosi na moguće štetne učinke povezane s taloženje gadolinija u mozgu: „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.
In view of (a) the evidence suggesting that linear GdCAs release Gd from their chelating ligand molecules due to the low kinetic and thermodynamic stability; (b) the known toxicity of unchelated gadolinium; (c) the data supporting the ability of linear GdCAs to distribute and accumulate in the brain; (d) the fact that linear agents are retained and persist for up to one year or longer in the brain; and (e) the deposition in other tissues with related harm; PRAC considered that there are reasonable and serious concerns raised as to the potential of neurological harm associated with the accumulation of gadolinium in the brain. 
Uzimajući u obzir (a) dokaz koji govori da linearni GdCA-ovi otpuštaju gadolinij iz kelacijskih molekula liganda zbog niske kinetičke i termodinamičke stabilnosti; (b) poznatu toksičnost nekelacijskog gadolinija; (c) podatke koji pokazuju sposobnost linearnih GdCA-ova da se distribuiraju i talože u mozgu; (d) činjenicu da se linearna sredstva zadržavaju u mozgu jednu godinu ili duže; i (e) taloženje u drugim tkivima uz povezanu štetu; PRAC smatra da postoje razumne i ozbiljne zabrinutosti u pogledu neurološkog oštećenja uzrokovanog taloženjem gadolinija u mozgu.
A rat study also confirmed the finding that dose-dependent level of Gd in the brain for linear agents was likely to be related to cumulative dose rather than a single large or repeat small dose regimens. 
Ispitivanje na štakorima potvrdilo je i da je razina gadolinija u mozgu ovisno o dozi linearnih sredstava vjerojatno povezana s ukupnom dozom, a ne jednom velikom ili više malih doza.
Therefore, PRAC considered that restriction of the use of linear GdCAs to certain indications or to certain groups of patients would not be justified and would still leave patients exposed to the risk of gadolinium brain accumulation and that risk minimisation measures such as warnings in the SmPC or other contraindications would not limit the exposure to linear GdCAs as no safe level of gadolinium brain accumulation has been established. 
Stoga PRAC smatra da ograničenje uporabe linearnih GdCA-ova na određene indikacije ili na određene skupine bolesnika ne bi bilo opravdano i da bi bolesnici i dalje bili izloženi riziku od taloženja gadolinija u mozgu te da mjere za smanjenje rizika kao što su upozorenja u sažetku opisa svojstava lijeka ili druge kontraindikacije ne bi ograničile izloženost linearnim GdCA-ovima jer nije utvrđena sigurna razina za taloženje gadolinija u mozgu.
Macrocyclic agents show only a transient increase in Gd in the brain and undergo early washout. 
Makrociklička sredstva pokazuju samo prijelazno povećanje gadolinija u mozgu i rano se ispiru.
In rat studies, residual Gd found in the rat brain after repeated administration of linear GdCAs was present in at least 3 distinctive forms - soluble small molecules, presumably intact GdCA, soluble macromolecules and to the largest extent an insoluble form. 
U ispitivanjima na štakorima, ostaci gadolinija u mozgu štakora nakon ponovljene primjene linearnih GdCA-ova pronađeni su u najmanje 3 različita oblika - topive male molekule, vjerojatno netaknuti GdCA, topive makromolekule i u najvećoj mjeri oblik koji nije topiv.
For the linear agent gadoxetic acid that has shown clinical utility in liver imaging, in view of its substantial liver uptake, its administration at a low dose (0.025 mmol/kg of body weight) and the short time to the delayed phase scanning (20 mins), the PRAC considered that it provides an additional benefit to patient management with an exposure to gadolinium that is minimised by the low dose administered and the short time to the delayed phase. 
U pogledu linearnog sredstva gadoksetične kiseline koja je pokazala kliničku korist pri snimanju jetre, uzimajući u obzir značajan unos u jetru, primjenu u niskoj dozi (0,025 mmol/kg tjelesne mase) i kratko vrijeme do odgođene faze snimanja (20 minuta), PRAC smatra da pruža dodatnu korist za upravljanje bolesnikom koji se izlaže gadoliniju jer se to izlaganje smanjuje primjenom niske doze i kratkim vremenom do odgođene faze.