2,5 Several investigators have proposed updated ULN of serum ALT

levels (Table 1). However, the ULN varies slightly in different reference populations. Prati et al.5 suggested ULN values of 30 IU/L for men and 19 IU/L for women in an Italian population, whereas Kang et al.11 proposed 31 IU/L for men and 23 IU/L for women among Koreans living in Asia. The higher proposed ULN values for the Korean population are likely due to the higher proportion of patients with mild NAFLD. Although ultrasonography screening was performed to exclude patients with NAFLD from the “healthy” population, this technique cannot consistently identify mild fatty liver affecting less than 33% of the liver, and some of these

patients were likely included in the reference population.13 Another reason for the PD0325901 nmr elevated Korean ULN values might be the higher mean age of the patients in the Korean study. Since serum ALT levels increase from the first to the fourth HM781-36B decade of life and decrease thereafter, different age distributions might thus affect ALT distribution. The ideal approach to the resolution of such confounding variables is to recruit patients with histologically-normal livers. However, in most cases, an invasive procedure, such as liver biopsy, is not a feasible ethical screening method. The establishment of the ideal ULN for serum ALT ultimately depends on the appropriate use of non-invasive diagnostic tools to successfully exclude patients with subclinical diseases in the liver and other organs from healthy reference populations.14 Skepticism about the need to update the current normal range of

serum ALT levels still exists due to a variety of concerns. First, such an undertaking might involve unnecessary testing and consultation, ultimately increasing the financial burdens of health-care provision.15 Second, potential many blood donors might be rejected solely because of minimally-elevated ALT values. Finally, a lowered ULN might bring about heightened patient anxiety and medicolegal concerns. A more practical solution to these concerns could be to divide the current ULN (40 IU/L) into optimal (< 30 IU/L) and borderline (30–39 IU/L) levels. Individuals with borderline ALT levels might be candidates for further studies of the secondary prevention of CLD.2,5 In conclusion, physicians should be cautious in interpreting the current normal range of serum ALT levels. Meticulous examination and education of patients with borderline serum ALT levels are recommended. To minimize selection bias in establishing the true normal range of serum ALT, further well-designed prospective studies are warranted. "
“This study was undertaken to evaluate the clinical characteristics, prognostic factors, and long-term outcomes of patients with mucosa-associated lymphoid tissue (MALT) lymphoma in the gastrointestinal (GI) tract.