natgillin/translations-raw huggingface dataset:
Furthermore, the discordance between the PK and PD data for Iffeza suggests that the PK data do not accurately reflect comparative pulmonary deposition and are not a valid surrogate for clinical effect. 
Poleg tega neskladje med farmakokinetičnimi in farmakodinamičnimi podatki za zdravilo Iffeza kaže, da farmakokinetični podatki ne odražajo pravilno primerjalnega odlaganja v pljuča in niso veljaven nadomestek za klinični učinek.
The apparent lower systemic availability of fluticasone propionate in Iffeza compared with GSK fluticasone propionate pMDI would not appear to result in a lesser clinical effect. 
Kaže, da navidezna manjša sistemska razpoložljivost flutikazon propionata v zdravilu Iffeza v primerjavi z vdihovalnikom s flutikazon propionatom GSK ne povzroča manjšega kliničnega učinka.
Furthermore, the CHMP noted that the need to demonstrate either pharmacokinetic equivalence or therapeutic equivalence to a reference product is not a requirement for this development, which was submitted according to Directive 2001/83/EC, Article 10b fixed combination application - requiring complete administrative and complete quality, non-clinical and clinical data on the combination only; the specific combination of these two well known active substances, fluticasone propionate and formorerol fumarate, is new, and therefore equivalence/therapeutic equivalence does not have to be proven. 
Odbor CHMP je nadalje omenil, da dokaz farmakokinetične ekvivalence ali terapevtske ekvivalence glede na referenčno zdravilo, predložen v skladu s členom 10b Direktive 2001/83/ES, uporaba fiksne kombinacije, ki zahteva popolne administrativne podatke in podatke o kakovosti ter predklinične in klinične podatke samo za kombinacijo, ni nujen za ta razvoj.
An annual exacerbation rate ratio of 0.98, i.e. very close to unity for the comparison of Iffeza 500µg/20µg versus fluticasone propionate 500µg + formoterol fumarate 24µg was therefore suggestive of non-inferiority but was not statistically definitive. 
Razmerje letne stopnje poslabšanja 0,98, ki pomeni, da skoraj ni razlike med zdravljenjem z zdravilom Iffeza 500 µg/20 µg in flutikazon propionatom 500 µg + formoterol fumaratom 24 µg, torej ni pokazalo slabšega učinka, vendar ni bilo statistično dokončno.
With regard to the “Step-up” indication, again the CHMP accepted the discussions presented by the Applicant and was of the view that the clinical effects of Iffeza in respect of asthma control are superior to the clinical effects of GSK fluticasone propionate administered alone. 
Tudi v zvezi z indikacijo „stopnjevanje zdravljenja“ je odbor CHMP sprejel razprave, ki jih je predložil predlagatelj, in je menil, da so klinični učinki zdravila Iffeza, kar zadeva obvladovanje astme, boljši od kliničnih učinkov flutikazon propionata GSK pri samostojni uporabi.
Iffeza 50/5, 125/5 and 250/10 microgram pressurised inhalation, suspension is a new fixed-dose combination of two well-known active drug substances fluticasone propionate and formoterol fumarate. 
Splošni povzetek znanstvenega vrednotenja zdravila Iffeza in povezanih imen (glejte Prilogo I) Zdravilo Iffeza 50/5, 125/5 in 250/10 mikrogramov, inhalacijska raztopina pod tlakom, je nova kombinacija fiksnih odmerkov dveh znanih zdravilnih učinkovin, flutikazon propionata in formoterol fumarata.
With regard to the “Switch” therapy, the CHMP accepted the discussions presented by the Applicant and was of the view that the clinical effects of Iffeza in respect of asthma control and exacerbation risk are comparable with/similar to the clinical effects of GSK fluticasone propionate and Novartis formoterol fumarate given concomitantly. 
V zvezi z zdravljenjem „prehod“ je odbor CHMP sprejel razprave, ki jih je predložil predlagatelj, ter je menil, da so klinični učinki zdravila Iffeza, kar zadeva obvladovanje astme in tveganja za poslabšanje, primerljivi s kliničnimi učinki flutikazon propionata GSK in Novartis formoterol fumarata, kadar se uporabljata sočasno, oziroma so jim podobni.
Data submitted by the Applicant demonstrated that asthma control with Iffeza is superior to that with fluticasone propionate pMDI alone and that asthma control with Iffeza is similar to that with fluticasone propionate pMDI + formoterol fumarate pMDI. 
Podatki, ki jih je predložil predlagatelj, kažejo, da je pri uporabi zdravila Iffeza obvladovanje astme boljše kot pri uporabi vdihovalnika s samim flutikazon propionatom in da je obvladovanje astme z zdravilom Iffeza podobno tistemu pri uporabi vdihovalnika s flutikazon propionatom + vdihovalnika s formoterol fumaratom.
The pre-dose FEV1 data in this study which were again a demonstrably inhaled corticosteroid-mediated effect provided no evidence of a lesser inhaled corticosteroid effect with Iffeza than seen with fluticasone propionate + formoterol fumarate. 
Podatki o predodmernem FEV1 v tej študiji, ki so tudi dokazano pomenili učinek, povezan z inhalacijskim kortikosteroidom, ne dokazujejo manjšega učinka inhalacijskega kortikosteroida z zdravilom Iffeza, kot so ga opazili pri flutikazon propionatu + formoterol fumaratu.
Overall summary of the scientific evaluation of Iffeza and associated names (see Annex I) 
pripravljene med postopkom Skupine za usklajevanje, kakor je navedeno v Prilogi III za zdravilo Iffeza in povezana imena (glejte Prilogo I).
The relative bioavailability of fluticasone propionate at steady state was 67% following Iffeza administration compared with GSK fluticasone propionate pMDI. 
Relativna biološka razpoložljivost flutikazon propionata v stanju dinamičnega ravnovesja po aplikaciji zdravila Iffeza je bila 67 % v primerjavi z vdihovalnikom s flutikazon propionatom GSK.
However, the specific formulation of a fixed-dose combination of these two well known active substances, fluticasone propionate and formoterol fumarate, is new. 
Vendar je specifična formulacija kombinacije fiksnih odmerkov teh dveh znanih zdravilnih učinkovin,
Turning to the available data in the Applicant's studies, for the “Step-up” comparison the odds of “any” exacerbation were 33% higher in fluticasone propionate- than Iffeza-treated patients (p=0.019) whilst the annual exacerbation rate was 49% higher in fluticasone propionate- than Iffeza-treated patients (p=0.004). 
Na podlagi razpoložljivih podatkov iz predlagateljevih študij je bila v primerjavi „stopnjevanje zdravljenja“ verjetnost „kakršnega koli“ poslabšanja za 33 % večja pri bolnikih, ki so dobivali flutikazon propionat, kot pri tistih, ki so dobivali zdravilo Iffeza (p = 0,019), medtem ko je bila letna stopnja poslabšanj za 49 % večja pri bolnikih, ki so dobivali flutikazon propionat, kot pri tistih, ki so dobivali zdravilo Iffeza (p = 0,004).
The clinical development programme for Iffeza was set up to evaluate efficacy and safety in the intended patient population. 
Za vrednotenje učinkovitosti in varnosti pri ciljni populaciji bolnikov je bil vzpostavljen klinični razvojni program za zdravilo Iffeza.
Approximately 20 subjects in each arm of this parallel group study were administered Iffeza 500/20 (fluticasone propionate 500µg and formoterol fumarate 20µg) or GSK fluticasone propionate 500µg pMDI + Novartis formoterol fumarate 24µg pMDI. 
Približno 20 oseb v vsakem kraku te študije z vzporednima skupinama je dobilo zdravilo Iffeza 500/20 (flutikazon propionat 500 µg in formoterol fumarat 20 µg) ali vdihovalnik s flutikazon propionatom GSK 500 µg + vdihovalnik z zdravilom Novartis formoterol fumarat 24 µg.
Whereas 
Ob upoštevanju, da:
Effects with the low dose of Iffeza (100µg/10µg) upon pre-dose FEV1 were similar to those with the high dose of GSK fluticasone propionate 500µg (alone or in combination with formoterol fumarate 24µg). 
Učinki majhnega odmerka zdravila Iffeza (100 µg/10 µg) na predodmerni FEV1 so bili podobni tistim pri velikem odmerku flutikazon propionata GSK 500 µg (samega ali v kombinaciji s formoterol fumaratom 24 µg).
• For patients already adequately controlled on both an inhaled corticosteroid and a long-acting β2 
• za bolnike, pri katerih je astma že ustrezno obvladana z uporabo kombinacije inhalacijskega kortikosteroida in β2-agonista z dolgotrajnim delovanjem [indikacija „prehod﻿ .
The data presented in respect of exacerbations demonstrate an increased protective benefit of Iffeza compared with GSK fluticasone propionate administered alone - the odds of any exacerbation occurring were 33% higher and the annual exacerbation rate was 49% higher in patients receiving GSK fluticasone propionate than in patients receiving Iffeza, p=0.019 and p=0.004, respectively. 
Predloženi podatki, povezani s poslabšanji, kažejo večjo zaščitno korist zdravila Iffeza v primerjavi s samim flutikazon propionatom GSK - verjetnost za pojav kakršnega koli poslabšanja je bila za 33 % večja in letna stopnja poslabšanja je bila za 49 % večja pri bolnikih, ki so dobivali flutikazon propionat GSK,
Of the five pivotal studies submitted with this Marketing Authorisation Application three studies were designed such that they facilitate a rigorous, internally validated examination as to whether the long-acting β2 agonist formoterol fumarate “masks” deficient corticosteroid effects of Iffeza upon pre-dose FEV1. 
Prikritje morebitnega manjšega kliničnega učinka kortikosteroida, ki ga povzroča ß2-agonist z dolgotrajnim delovanjem Od petih ključnih študij, predloženih s to vlogo za pridobitev dovoljenja za promet z zdravilom, so bile tri študije zasnovane tako, da lahko olajšajo strogo, interno potrjeno raziskavo, ali β2-agonist z dolgotrajnim delovanjem, formoterol fumarat, „prikriva“ nezadostne učinke kortikosteroida v zdravilu Iffeza na predodmerni FEV1.
The clinical findings suggest that fluticasone propionate in Iffeza is non-inferior in respect of clinical effects to GSK fluticasone propionate. 
Klinična odkritja kažejo, da flutikazon propionat v zdravilu Iffeza glede na klinične učinke ni slabši od flutikazon propionata GSK.
This comparison showed that despite a lower relative fluticasone propionate bioavailability, the effect upon pre-dose FEV1 (which was demonstrably mediated by fluticasone propionate alone in Study FLT3503) was numerically greater with Iffeza 500µg/20µg than with GSK fluticasone propionate 500µg (either alone or in conjunction with Novartis formoterol fumarate 24µg). 
Ta primerjava je pokazala, da je bil kljub manjši relativni biološki razpoložljivosti flutikazon propionata učinek na predodmerni forsirani ekspiracijski volumen (FEV1, ki ga je v študiji FLT3503 dokazano dosegel flutikazon propionat pri samostojni uporabi) številčno večji z zdravilom Iffeza 500 µg/20 µg kot s flutikazon propionatom GSK 500 µg (samim ali skupaj z Novartis formoterol fumaratom 24 µg).
In addition to the above is the observation from several published studies that FEV1 is maximal following approximately 8 to 12 weeks inhaled corticosteroid-based treatment and is stable thereafter. 
Temu se pridružuje ugotovitev iz več objavljenih študij, da je FEV1 največji po približno od 8 do
Study FLT 3503 also included a comparison with a lower dose of Iffeza and effects seen with this lower dose of Iffeza (100µg/10µg) upon pre-dose FEV1 were similar to those seen with the high dose of GSK fluticasone propionate 500µg (administered both alone or in combination with formoterol fumarate 24µg). 
Študija FLT3503 je vključevala tudi primerjavo z manjšim odmerkom zdravila in učinki tega manjšega odmerka zdravila Iffeza (100 µg/10 µg) na predodmerni FEV1 so bili podobni tistim pri velikem odmerku flutikazon propionata GSK 500 µg (samega ali v kombinaciji s formoterol fumaratom 24 µg).
The Applicant presented some reasons which could potentially explain such discordance: this could be a function of the deviation of orally inhaled product (OIP) pulmonary PK from standard PK principles, i.e. unlike conventional PK analysis (e.g. for tablets) blood concentrations of OIPs are a “post-event” (rather than “pre-event”) surrogate for efficacy and standard PK analysis does not necessarily define drug residence at the pulmonary site of action. 
To pomeni, da so za razliko od običajne farmakokinetične analize (npr. za tablete) koncentracije peroralnega inhalacijskega zdravila v krvi nadomestek za učinkovitost „po dogodku“ (in ne „pred dogodkom“), zato običajna farmakokinetična analiza morda ne opredeljuje zadrževanja zdravila na mestu delovanja v pljučih.
The objecting Member State stated that proof of similar control of inflammation by fluticasone in this new fixed-dose combination product compared with fluticasone as monotherapy or in combination with other long-acting β2 agonists has not been established either in pharmacokinetic studies or in clinical studies. 
da bi flutikazon v tej novi kombinaciji fiksnih odmerkov podobno obvladoval vnetje v primerjavi s flutikazonom kot samostojnim zdravljenjem ali v kombinaciji z drugimi β2-agonisti z dolgotrajnim delovanjem.
the CHMP has recommended the granting of the marketing authorisation for which the summary of product characteristics, labelling and package leaflet remain as per the final versions achieved during the Coordination group procedure as mentioned in Annex III for Iffeza and associated names (see Annex I). 
je odbor CHMP priporočil izdajo dovoljenja za promet z zdravilom, za katerega ostajajo povzetek glavnih značilnosti zdravila, označevanje in navodilo za uporabo enaki kot zadnje različice,
These PK and PD studies both included the same strengths/doses of Iffeza, GSK fluticasone propionate pMDI and Novartis formoterol fumarate pMDI, and all products in both studies were administered via the same spacing device, so allowing a valid comparison of PK and PD data. 
Obe farmakokinetični in farmakodinamični študiji sta vključevali enake jakosti/odmerke zdravila Iffeza, vdihovalnikov s flutikazon propionatom GSK in vdihovalnikov z zdravilom Novartis formoterol fumarat.
In addition, the comparison of these PK data with PD data, Study FLT3503, shows that despite the lower relative bioavailability of fluticasone propionate in this new fixed-dose combination product the effect upon predose FEV1 (which was demonstrably mediated by fluticasone propionate alone in Study FLT3503) was numerically greater with Iffeza 500µg/20µg than with GSK fluticasone propionate 500µg (either administered alone or administered together with Novartis formoterol fumarate 24µg). 
Poleg tega primerjava farmakokinetičnih podatkov s farmakodinamičnimi podatki iz študije FLT3503 kaže, da je bil kljub manjši relativni biološki razpoložljivosti flutikazon propionata v tej novi kombinaciji fiksnih odmerkov učinek na predodmerni forsirani ekspiracijski volumen FEV1 (ki ga je v študiji FLT3503 dokazano dosegel flutikazon propionat pri samostojni uporabi) številčno večji z zdravilom Iffeza
These endpoints were demonstrably inhaled cortocosteroid-driven and/or inhaled corticosteroid dose-responsive and all provided rigorous statistical evidence that the inhaled corticosteroid effects of Iffeza were not less than those of fluticasone propionate + formoterol fumarate. 
Te končne točke je dokazano povzročil inhalacijski kortikosteroid oziroma so bile odvisne od odmerka inhalacijskega kortikosteroida ter so vse priskrbele natančne statistične dokaze,
With regard to the “Switch” indication, the proportion of patients experiencing exacerbations in the pivotal “Switch” study (Study FLT3503) was similar in Iffeza and fluticasone propionate + formoterol fumarate treated patients (36.4% and 35.3%, respectively) although this analysis lacked discriminative capacity as the proportion of fluticasone propionate monotherapy-treated patients experiencing exacerbations was similar (37.4%). 
„prehod“ (študiji FLT3503) podoben pri bolnikih, ki so dobivali Iffeza, in pri tistih, ki so se zdravili s flutikazon propionatom + formoterol fumaratom (36,4 % oziroma 35,3 %).
However, an analysis of annualised exacerbation rates in this study was able to differentiate the effects of high dose ICS-LABA (inhaled corticosteroid - long-acting β2 agonist) treatments (Iffeza 500µg/20µg and fluticasone propionate 500µg + formoterol fumarate 24µg) from low dose ICS-LABA treatment (fluticasone propionate 100µg/10µg) and fluticasone propionate 500µg monotherapy. 
(inhalacijski kortikosteroid - β2-agonist z dolgotrajnim delovanjem) (Iffeza 500 µg/20 µg in flutikazon propionat 500 µg + formoterol fumarat 24 µg) od zdravljenja z majhnimi odmerki ICSLABA (flutikazon propionat 100 µg/10 µg) in samostojnega zdravljenja s flutikazon propionatom 500 µg.
The designs of the clinical studies were not appropriate to establish equivalent control of inflammation because in order to distinguish a potential difference between two ICS products, exacerbations (particularly severe exacerbations) are the indicated parameter. 
parameter, ki bi ga potrebovali za odkrivanje morebitnih razlik med zdraviloma z inhalacijskim kortikosteroidom, so namreč poslabšanja, zlasti huda poslabšanja.
• For patients not adequately controlled with inhaled corticosteroids and ‘as required' inhaled shortacting β2 agonist. 
• za bolnike, pri katerih astma ni ustrezno obvladana z uporabo inhalacijskih kortikosteroidov in,
These data were generated from the five pivotal 8- to 12-week studies and demonstrate the protective benefit of Iffeza against exacerbations compared with fluticasone propionate monotherapy. 
tedenskih študij in kažejo, da je zdravilo Iffeza v primerjavi s samostojnim zdravljenjem s flutikazon propionatom koristno kot zaščita proti poslabšanjem.
Patients can then continue with either 1.5 mg/kg once every week, 3 mg/kg every 2 weeks, or 6 mg/kg every 4 weeks. 
Bolniki lahko nato nadaljujejo bodisi z odmerkom v jakosti 1,5 mg/kg enkrat na teden, 3 mg/kg vsaka dva tedna bodisi 6 mg/kg vsake štiri tedne.
The European Medicines Agency therefore decided that Hemlibra's benefits are greater than its risks and it can be authorised for use in the EU. 
Evropska agencija za zdravila je zato zaključila, da so koristi zdravila Hemlibra večje od z njim povezanih tveganj in da se lahko odobri za uporabo v EU.
What measures are being taken to ensure the safe and effective use of Hemlibra? 
Kateri ukrepi se izvajajo za zagotovitev varne in učinkovite uporabe zdravila Hemlibra?
Hemlibra received a marketing authorisation valid throughout the EU on 23 February 2018. 
Za zdravilo Hemlibra je bilo 23. februarja 2018 izdano dovoljenje za promet, veljavno po vsej Evropski uniji.
The recommended dose is 3 mg per kg of bodyweight once every week for the first 4 weeks. 
Priporočeni odmerek zdravila je 3 mg na kilogram telesne mase enkrat na teden prve štiri tedne.
Hemlibra is intended for longterm use. 
Zdravilo Hemlibra je namenjeno dolgotrajni uporabi.
Other information about Hemlibra 
Druge informacije o zdravilu Hemlibra
What benefits of Hemlibra have been shown in studies? 
Kakšne koristi zdravila Hemlibra so se pokazale v študijah?
As for all medicines, data on the use of Hemlibra is continuously monitored. 
Tako kot za vsako zdravilo se tudi podatki o uporabi zdravila Hemlibra stalno spremljajo.
Materials will include product information, guides, and a patient alert card. 
Gradivo bo vključevalo informacije o zdravilu, vodnike in opozorilno kartico za bolnike.
Why is Hemlibra authorised in the EU? 
Zakaj je bilo zdravilo Hemlibra odobreno v EU?
What are the risks associated with Hemlibra? 
Kakšna tveganja so povezana z zdravilom Hemlibra?
An overview of Hemlibra and why it is authorised in the EU 
Pregled zdravila Hemlibra in zakaj je odobreno v EU
The study also enrolled patients who were already taking preventive treatment with medicines known as bypassing agents. 
Študija je vključevala tudi bolnike, ki so že prejemali preventivno zdravljenje z zdravili, imenovanimi obvodna zdravila.
Hemlibra reduces bleeding episodes in these patients and increases their quality of life. 
Zdravilo Hemlibra zmanjšuje število krvavitev pri teh bolnikih in povečuje kakovost njihovega življenja.
Side effects reported with Hemlibra are carefully evaluated and any necessary action taken to protect patients. 
Neželeni učinki, o katerih so poročali pri zdravilu Hemlibra, se skrbno ovrednotijo in po potrebi se sprejmejo ukrepi za zaščito bolnikov.
The dose of Hemlibra depends on the patient's bodyweight. 
Odmerek zdravila Hemlibra je odvisen od bolnikove telesne mase.
What is Hemlibra and what is it used for? 
Kaj je zdravilo Hemlibra in za kaj se uporablja?
Because emicizumab has a different structure to factor VIII, it is not affected by factor VIII inhibitors. 
Ker ima emicizumab drugačno zgradbo od faktorja VIII, zaviralci faktorja VIII nanj ne vplivajo.
Recommendations and precautions to be followed by healthcare professionals and patients for the safe and effective use of Hemlibra have also been included in the summary of product characteristics and the package leaflet. 
Priporočila in previdnostni ukrepi, ki jih morajo za varno in učinkovito uporabo zdravila Hemlibra upoštevati zdravstveni delavci in bolniki, so vključeni tudi v povzetek glavnih značilnosti zdravila in navodilo za uporabo.
Patients or their carers may be able to inject Hemlibra at home once they have been trained appropriately. 
Bolniki ali njihovi skrbniki lahko po ustreznem usposabljanju zdravilo Hemlibra injicirajo sami doma.
The company that markets Hemlibra will issue educational materials for healthcare professionals, patients, carers and laboratory professionals about abnormal clotting side effects, the risk of taking Hemlibra at the same time as bypassing agents and how laboratory tests should be carried out for these patients. 
Družba, ki trži zdravilo Hemlibra, bo izdala izobraževalno gradivo za zdravstvene delavce, bolnike, skrbnike in laboratorijske delavce o neželenih učinkih nenormalnega strjevanja, tveganju jemanja zdravila Hemlibra sočasno z obvodnimi zdravili in načinu izvajanja laboratorijskih preiskav pri teh bolnikih.
Patients receiving Hemlibra also had better quality of life scores than those who were not given Hemlibra. 
Bolniki, ki so prejemali zdravilo Hemlibra, so tudi bolje ocenili kakovost življenja kot tisti, ki tega zdravila niso prejemali.
For more information about using Hemlibra, see the package leaflet or contact your doctor or pharmacist. 
Za več informacij glede uporabe zdravila Hemlibra glejte navodilo za uporabo ali se posvetujte z zdravnikom ali farmacevtom.
The most serious side effect is thrombotic microangiopathy (clots in small blood vessels, which may affect up to 1 in 100 people). 
Najresnejši neželeni učinki so trombotična mikroangiopatija (strdki v majhnih krvnih žilah, ki se lahko pojavijo pri največ 1 bolniku od 100).
The active substance in Hemlibra, emicizumab, is a monoclonal antibody which has been designed to do the work that factor VIII normally does - bringing together 2 clotting factors (IXa and X) as part of a chain of reactions needed for blood to clot. 
Učinkovina v zdravilu Hemlibra, emicizumab, je monoklonsko protitelo, ki je bilo zasnovano za opravljanje dela, ki ga običajno opravlja faktor VIII - povezovanje dveh faktorjev strjevanja krvi (IXa in X) kot del verige reakcij, potrebnih za strjevanje krvi.
The side effects with Hemlibra are tolerable and information on how to manage the risks of serious side effects is in the prescribing information and educational materials. 
Neželeni učinki zdravila Hemlibra so sprejemljivi, informacije o obvladovanju tveganja za resne neželene učinke pa so v informacijah o predpisovanju zdravila in izobraževalnem gradivu.
This overview was last updated in 03-2019. 
Nadaljnje informacije o zdravilu Hemlibra so na voljo na spletni strani agencije: Pregled je bil nazadnje posodobljen 03-2019.
The most common side effects with Hemlibra (which may affect 1 in 10 people or more) are redness, itching or pain at the place where it is injected, headache and joint pain. 
Najpogostejši neželeni učinki zdravila Hemlibra (ki se lahko pojavijo pri 1 ali več od 10 bolnikov) so pordelost, srbenje ali bolečina na mestu injiciranja, glavobol in bolečina v sklepih.
The arm injection should only be given by a caregiver or healthcare professional. 
Injekcijo v nadlaket smejo dajati samo skrbniki ali zdravstveni delavci.
Hemlibra is available as a solution for injection under the skin in the belly, thigh or upper arm. 
Zdravilo Hemlibra je na voljo v obliki raztopine za injiciranje pod kožo v trebuh, stegno ali nadlaket.