natgillin/translations-raw huggingface dataset:
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. 
Za gadoksetno kislino (linearno sredstvo), ki se je izkazala za klinično koristno pri slikanju jeter, je odbor PRAC glede na to, da se v znatni meri absorbira v jetra, da se uporablja v majhnem odmerku (0,025 mmol/kg telesne mase) in da do zapoznele faze slikanja poteče malo časa (20 minut), menil, da zagotavlja dodatno korist pri obravnavanju bolnikov, pri čemer se izpostavljenost gadoliniju zaradi uporabljenega majhnega odmerka in kratkega časa do zapoznele faze zmanjša.
A higher in vivo than in vitro stability would require the occurrence of stabilising agents in vivo, but no conclusive evidence confirming increases of the stability of the Gd complex in the body has been provided by the MAH. 
Višja stabilnost in vivo kot in vitro bi zahtevala pojav stabilizatorjev in vivo, imetnik dovoljenja za promet z zdravilom pa ni predložil trdnega dokaza za povečanje stabilnosti gadolinijevega kompleksa.
Particularly zinc, copper and iron (Frenzel et al., 2008) are described as competing metals which can liberate Gd; glycosaminoglycans like heparin may bind Gd and thereby remove it from its pharmacological chelator. 
Kot konkurenčne kovine, ki lahko povzročijo sproščanje gadolinija, so opisani zlasti cink, baker in železo (Frenzel idr., 2008); glikozaminoglikani, kot je heparin, lahko vežejo gadolinij in ga tako odstranijo iz njegovega farmakološkega kelatorja.
Based on the knowledge of the function of the affected brain areas (including DN and GP), these effects would include effects on fine motor skills or cognitive impairment, particularly in those with ongoing neurological disease which may mask these events. 
Na podlagi poznavanja delovanja poškodovanih predelov možganov (vključno z DN in GP) bi ti učinki vključevali učinke na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo, ki lahko te dogodke prikrije.
An in vitro study in rat neurons reported gadolinium-induced cytotoxicity via oxidative injury. 
Študija in vitro na nevronih podgane je pokazala citotoksičnost, ki jo je povzročil gadolinij prek oksidativne poškodbe.
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. 
Pri makrocikličnih sredstvih je bilo ugotovljeno samo začasno povečanje intenzivnosti signala T1 in koncentracije gadolinija (merjeno z ICP-MS1, zato se molekularna oblika gadolinija ni zaznala).
Non-chelated gadolinium has been shown to be toxic in non-clinical studies, with effects including cellular necrosis, fibrosis, and lesions related to mineral deposition. 
V nekliničnih študijah se je dokazalo, da je nekelatiran gadolinij toksičen ter med drugim povzroča celično nekrozo, fibrozo in lezije, povezane z odlaganjem mineralov.
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. 
Poleg tega so bili pri sredstvih GdCA ugotovljeni toksični učinki tudi v drugih organih, npr. v ledvicah (kjer povzročijo NSF) in na koži (kjer povzročijo kožni plak), za katere se domneva, da so povezani z gadolinijem, ki se sprošča iz kelata.
Therefore, taking into account the serious concerns about the potential neurological harm, deposition in other tissues and its potential risks, and the already identified risks associated with the use of linear GdCAs (including the significant risk of NSF and the gadolinium-associated plaques), the PRAC considered that the benefit in enhancement of MR images does not outweigh the known and potential risks of these products. 
Odbor PRAC je ob upoštevanju resnih pomislekov glede morebitnih škodljivih nevroloških učinkov, odlaganja v drugih tkivih in njegovih morebitnih tveganj ter že opredeljenih tveganj, povezanih z uporabo linearnih sredstev GdCA (vključno z znatnim tveganjem NSF in z gadolinijem povezanih plakov) menil, da korist pri izboljšanju kontrasta na magnetnoresonančnih slikah ne prevlada nad znanimi in morebitnimi tveganji teh izdelkov.
Accumulation in the brain 
Kopičenje v možganih
While accumulation in terms of T1w signal intensity increases and gadolinium measured in the brain (likely in the form of intact GdCA molecule) has been seen in the short term with these agents, long-term persistence in the brain was not be observed. 
Čeprav je bilo pri teh sredstvih ugotovljeno kratkotrajno kopičenje glede na povečanje intenzivnosti signala T1w in gadolinija, merjenega v možganih (verjetno v obliki nespremenjene molekule sredstva GdCA), pa dolgotrajno zadrževanje v možganih ni bilo ugotovljeno.
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. 
Podatki kažejo, da naj bi se tudi makrociklična sredstva odlagala v možganih, vendar pa se gadolinij poveča samo začasno in se kmalu izperejo.
There are several publications in rat models that have demonstrated a T1-weighted signal enhancement in the deep cerebellar nuclei (DCN) - the equivalent to the dentate nucleus (DN) in humans- after administration of the linear agents. 
Na podlagi modelov s podgano je bilo objavljenih več primerov, ki so dokazali, da se po uporabi linearnih sredstev poveča T1-obtežen signal v globokih možganskih jedrih (DCN) - ki ustrezajo dentatnemu jedru (Nucleus dentatus - DN) pri ljudeh.
In addition, with regards to the SmPCs of macrocyclic GdCAs (Dotarem, Prohance, and Gadovist) recommending higher dose in CNS imaging to improve visualisation and angiography but not in whole body imaging, PRAC considered that clinically relevant differences in diagnostic performance between Multihance and macrocyclic agents need to be supported by robust evidence from comparative clinical studies rather than a comparison of the approved SmPCs, which may have limitations. 
Odbor PRAC je v zvezi s povzetki glavnih značilnosti zdravila za makrociklična sredstva GdCa (Dotarem, Prohance in Gadovist), v katerih se za boljšo vizualizacijo priporoča višji odmerek pri slikanju centralnega živčnega sistema in angiografiji, ne pa tudi pri slikanju celega telesa, menil, da bi bilo treba klinično pomembne razlike glede diagnostične zmogljivosti sredstva Multihance in makrocikličnih sredstev podpreti s trdnimi dokazi iz primerjalnih kliničnih študij in ne s primerjavo odobrenih povzetkov glavnih značilnosti zdravila, ki imajo lahko omejitve.
Non-clinical evidence also shows potential for release of gadolinium from the chelating ligand in the brain with linear GdCAs; the potential of release from the chelating ligand is not seen with macrocyclic GdCAs. 
Neklinični dokazi tudi kažejo možnost sproščanja gadolinija iz kelatnega liganda v možganih pri linearnih sredstvih GdCA; pri makrocikličnih sredstvih GdCA možnost sproščanja iz kelatnega liganda ni bila ugotovljena.
There is currently a cumulative amount of evidence in the literature that gadolinium is deposited in the brain. 
V literaturi se je do zdaj nabralo kar nekaj dokazov o odlaganju gadolinija v možganih.
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. 
Neželeni učinki so lahko zapozneli in komaj zaznavni, vključno z učinkom na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo.
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. 
Druga študija je dokazala, da so imele podgane, ki so prejele linearni sredstvi GdCA, in sicer gadodiamid in gadobensko kislino neposredno v cerebrospinalno tekočino, do pet tednov po uporabi povečano intenzivnost signala v globokih možganskih jedrih.
Spontaneous release of Gd from its chelator, competition of Gd with other metals (e.g. in metal rich areas of the brain), and competition of the chelator with other chelators (e.g. macromolecules) can occur in the body. 
V telesu se lahko pojavi spontano sproščanje gadolinija iz njegovega kelatorja, tekmovanje gadolinija z drugimi kovinami (npr. v predelih možganov, bogatih s kovinami) in tekmovanje kelatorja z drugimi kelatorji (npr. makromolekulami).
In order to minimise the risk of Gd accumulation in the brain and the potential associated harm in relation to linear GdCAs, PRAC considered options for risk minimisation measures such as warnings in the SmPC, contraindications and other additional risk minimisation measures. 
Odbor PRAC je za zmanjšanje tveganja kopičenja gadolinija v možganih in morebitno povezanih škodljivih učinkov v zvezi z linearnimi sredstvi GdCA proučil mogoče ukrepe za zmanjšanje tveganja, kot so opozorila v povzetku glavnih značilnosti zdravila, kontraindikacije in drugi dodatni ukrepi za zmanjšanje tveganja.
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. 
Odbor PRAC je glede na dokaze o kopičenju gadolinija v možganih in verjetne škodljive učinke ter kopičenje gadolinija v drugih tkivih in opredeljena povezana tveganja ter ob upoštevanju dejstva, da manj omejevalni ukrepi za zmanjšanje tveganja niso izvedljivi ali ne zadostujejo za zagotovitev sprejemljive ravni tveganja kopičenja gadolinija v možganih in drugih tkivih, menil, da je začasni umik dovoljenja za promet z linearnimi sredstvi GdCA za intravensko uporabo najprimernejši ukrep za zmanjšanje tveganj, povezanih s temi izdelki.
Although no adverse neurological effects have yet been demonstrated to be caused by gadolinium accumulation in the brain, long-term safety data are limited. 
Čeprav še niso bili dokazani neželeni nevrološki učinki, ki naj bi jih povzročilo kopičenje gadolinija v možganih, so podatki o dolgoročni varnosti omejeni.
Gadolinium-associated plaques 
Plaki, povezani z gadolinijem
• 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, CHMP considered that the benefits of this product outweigh its risks. 
• odbor CHMP je v zvezi s sredstvom Magnevist (gadopentetska kislina) za intraartikularno injiciranje glede na majhen odmerek, omejeno možnost večkratne izpostavljenosti bolnikov in neobstoj dokazov o kopičenju v možganih, menil, da koristi tega izdelka prevladajo nad njegovimi tveganji.
• 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. 
• odbor PRAC je v zvezi s sredstvom Magnevist (gadopentetska kislina) za intraartikularno injiciranje glede na majhen odmerek, omejeno možnost večkratne izpostavljenosti bolnikov in neobstoj dokazov za kopičenje v možganih, menil, da koristi tega izdelka prevladajo nad njegovimi tveganji.
Regarding the validity of an ex-vivo distribution study by Frenzel et al (2017), PRAC acknowledged the study does not contribute to the understanding in which form exactly Gd-based contrast agents are stored in the body, however PRAC considered that the study confirms, in line with other studies, that linear chelators lead to a higher amount of stored Gd and that there is a difference between linear and macrocyclic chelators in respect to binding to insoluble macromolecules. 
(2017), priznal, da študija ne prispeva k razumevanju, v točno kakšni obliki se kontrastna sredstva, ki temeljijo na gadoliniju, shranjujejo v telesu, kljub temu pa je menil, da študija v skladu z drugimi študijami potrjuje, da linearni kelatorji povzročijo večjo količino shranjenega gadolinija ter da pri vezavi na netopne makromolekule obstaja razlika med linearnimi in makrocikličnimi kelatorji.
Macrocyclic agents show only a transient increase in Gd in the brain and undergo early washout. 
Makrociklična sredstva kažejo samo začasno povečanje gadolinija v možganih in se kmalu izperejo;
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 izdelka prehajata v hepatocite in sta zato klinično koristna za slikanje slabo vaskulariziranih jetrnih lezij, zlasti pri slikanju v zapozneli fazi, ki jih s sredstvi, ki ne prehajajo v hepatocite, ni mogoče ustrezno proučiti, ter tako omogočata zgodnje diagnosticiranje morebitnih življenjsko nevarnih bolezni.
In addition, low concentrations of linear gadolinium agents as well as macrocyclic agents were detected in non-clinical and clinical studies via mass spectrometry. 
Poleg tega so bile z masno spektrometrijo v nekliničnih in kliničnih študijah ugotovljene nizke koncentracije linearnih in makrocikličnih sredstev, ki vsebujejo gadolinij.
Gadoxetic acid has a substantial liver uptake, is administered at a low dose (0.025 mmol/kg of body weight) and has a short time to delayed phase scanning (20 mins). 
Gadoksetna kislina, ki jo jetra večinoma absorbirajo, se uporablja v majhnem odmerku (0,025 mmol/kg telesne mase), čas do zapoznele faze slikanja pa je kratek (20 minut).
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. 
Odbor PRAC je ob upoštevanju dokazov o kopičenju sredstev GdCA v možganih, dejstva, da so bile linearne spojine v možganih ugotovljene v veliko večji količini kot makrociklične spojine in da so se v možganih ohranile dlje časa ter ob upoštevanju toksičnosti gadolinija, dokazane v nekliničnih študijah, resnih pomislekov v zvezi z morebitnimi škodljivimi nevrološkimi učinki, odlaganjem v drugih tkivih ter njegovimi morebitnimi in opredeljenimi tveganji, povezanimi z uporabo linearnih sredstev GdCA (vključno s tveganjem NSF in z gadolinijem povezanih plakov), ter glede na celoten varnostni profil teh sredstev vztrajal pri zaključku, da korist linearnih sredstev za intravensko uporabo pri izboljšanju kontrasta magnetnoresonančnih slik ne prevlada nad znanimi in morebitnimi tveganji teh izdelkov.
PRAC also considered the two linear GdCAs, gadoxetic acid and gadobenic acid in the liver imaging indication. 
Odbor PRAC je tudi proučil dve linearni sredstvi GdCA, in sicer gadoksetno kislino in gadobensko kislino, za indikacijo slikanja jeter.
For liver imaging, some GdCAs allow the possibility of a delayed phase imaging. 
Nekatera sredstva GdCA omogočajo slikanje jeter v zapozneli fazi.
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. 
Znano je tudi, da se pri podganah zaradi ledvične okvare poveča dolgoročno zadrževanje gadolinija v skladu z nagnjenostjo sredstev GdCA k sproščanju gadolinija in vivo.
These products have an uptake by hepatocytes and can provide in addition to the dynamic phase imaging a delayed phase imaging for highly vascularised hepatic lesions and to detect lesions that are visible only in the delayed phase. 
Ta izdelka, ki ju hepatociti absorbirajo, omogočata slikanje v dinamični in zapozneli fazi pri zelo vaskulariziranih jetrnih lezijah ter pri odkrivanju lezij, ki jih je mogoče videti samo v zapozneli fazi.
Linear GdCAs products 
Linearni izdelki GdCA
In view of the affected brain areas (including DN and GP), potential neurological effects would include effects on fine motor skills or cognitive impairment, particularly in patients with ongoing neurological disease, which may mask these events. 
Morebitni nevrološki učinki bi lahko glede na poškodovane predele možganov (ki vključujejo DN in GP) vključevali učinke na finomotorične sposobnosti ali kognitivno poslabšanje, zlasti pri bolnikih z nevrološko boleznijo, ki lahko prikrije te dogodke.
Intra-articular GdCA products 
Izdelki GdCA za intraartikularno uporabo
• Furthermore, dense deposits in various tissues were detected after GdCA administration by Transmission electron microscopy (TEM), which were regarded as Gd deposits. 
• poleg tega so bile po uporabi sredstva GdCA s transmisijsko elektronsko mikroskopijo (TEM) ugotovljeni gosti depoziti v različnih tkivih, ki so se šteli za depozite gadolinija.
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). 
V nekliničnih študijah se je pokazalo, da je nekelatiran gadolinij v obliki gadolinijevega klorida toksičen ter med drugim povzroča celično nekrozo, fibrozo in lezije, povezane z odlaganjem mineralov (Spencer idr., 1997; Rees idr.
There is no strong evidence of a true difference in the rate of hypersensitivity reactions or other acute reactions associated with GdCAs or of a difference in the rate of ADRs with a fatal outcome across the class. 
Trdni dokazi, da se sredstva GdCA iz tega razreda med seboj dejansko razlikujejo glede na stopnjo z njimi povezanih preobčutljivostnih reakcij ali drugih akutnih reakcij ter glede na stopnjo neželenih učinkov zdravila s smrtnim izidom, niso na voljo.
Deposition of gadolinium in the brain 
Odlaganje gadolinija v možganih
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. 
Odbor CHMP je tudi zaključil, da obstajajo praktične težave za učinkovito omejitev števila odmerkov, ki jih bolnik prejme v svojem življenju;
• 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. 
• odbor PRAC je menil, da tveganje, povezano z linearnimi sredstvi GdCA za intravensko uporabo, tj. z gadobensko kislino (pri vseh indikacijah, razen slikanja jeter), gadodiamidom, gadopentetsko kislino in gadoversetamidom, ob upoštevanju celotnega varnostnega profila, vključno z dodatnim morebitnim tveganjem škodljivih učinkov zaradi kopičenja v možganih in drugih tkivih, prevlada nad koristmi;
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. 
Odbor PRAC je v okviru postopka v skladu s členom 31 Direktive 2001/83/ES proučil vse razpoložljive podatke o varnosti in učinkovitosti zdravil, ki vsebujejo gadodiamid, gadopentetsko kislino, gadobensko kislino, gadoksetno kislino, gadoteridol, gadobutrol, gadotersko kislino in gadoversetamid.
• 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. 
• odbor CHMP je menil, da tveganje, povezano z linearnimi sredstvi GdCA za intravensko uporabo, tj. z gadobensko kislino (pri vseh indikacijah, razen slikanja jeter), gadodiamidom, gadopentetsko kislino in gadoversetamidom, ob upoštevanju celotnega varnostnega profila, vključno z dodatnim morebitnim tveganjem škodljivih učinkov zaradi kopičenja v možganih in drugih tkivih, prevlada nad koristmi;
The clinical finding (e.g. Radbruch et al.) that macrocyclic agents do not cause brain T1 hyperintensity was replicated by other groups and can therefore be considered to be substantiated. 
), da makrociklična sredstva ne povzročajo hiperintenzivnosti T1, so ponovile druge skupine, zato je zanjo mogoče šteti, da je utemeljena.
• 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. 
• odbor CHMP je upošteval, da linearni sredstvi za intravensko uporabo, tj. Multihance (gadobenska kislina) in Primovist (gadoksetna kislina), prehajata v hepatocite, zato sta klinično koristni za slikanje slabo vaskulariziranih jetrnih lezij, zlasti pri slikanju v zapozneli fazi, ki jih s sredstvi, ki ne prehajajo v hepatocite, ni mogoče ustrezno proučiti, ter tako omogočata zgodnje diagnosticiranje morebitnih življenjsko nevarnih bolezni.
In non-clinical studies (Robert et al. 2016 Lohrke et al. 2015; Lohrke et al. 2016; Kartamihardja et al. 2016a; Kartamihardja et al. 2016b; Smith et al. 2017; Rasschaert et al. 2016; MAH unpublished studies) the levels were typically around 10-fold higher with linear agents. 
V nekliničnih študijah (Robert idr., 2016, Lohrke idr.
• 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. 
• V nekliničnih in kliničnih študijah so poročali o kopičenju gadolinija tudi v različnih drugih tkivih, vključno z jetri, ledvicami, mišicami, kožo in kostmi.
PRAC noted that gadoxetic acid has only the liver imaging indication. 
Poudaril je, da ima gadoksetna kislina samo eno indikacijo, in sicer slikanje jeter.