Objective: Lumbar foraminal stenosis can lead radiculopathy in a subset of patients. Imaging findings have a high false-positive rate. The Kemp test is a provocative maneuver that has traditionally been used for diagnosing facet joint disease. However, it has shown an increased likelihood of concomitant foraminal stenosis. Thus we evaluated the diagnostic accuracy of a modified version of Kemp test (the Singh-Hartl foraminal compression test) in the diagnosis of symptomatic foraminal stenosis. Methods: Fifty consecutive patients with radiculopathy were enrolled. Participants were asked to perform the Singh-Hartl foraminal compression test, with a positive result if there was reproduction of radicular symptoms. Selective nerve root block (SNRB) was then performed at the suspected level. Visual analogue scores (VAS) were collected before and 15-minutes postprocedure. VAS improvement was calculated as a percentage. Various statistical analyses were conducted considering 2 different threshold (75% or 80% improvement in VAS). Results: Twenty-eight participants (56%) were women, with an average age of 47.3 years. L4 was most commonly involved (n=20). Using 75% improvement as the VAS threshold, the test had a sensitivity of 0.72 (95% confidence interval [CI], 0.53–0.87), specificity of 0.57 (95% CI, 0.34–0.78), PPV of 0.70 (95% CI, 0.56–0.79), and NPV of 0.60 (95% CI, 0.43–0.75). When using 80% improvement as the VAS threshold, the test had a sensitivity of 0.64 (95% CI, 0.41–0.83), specificity of 0.43 (95% CI, 0.24–0.63), PPV of 0.47 (95% CI, 0.36–0.58), and NPV of 0.60 (95% CI, 0.43–0.75). Conclusion The Singh-Hartl maneuver exhibited moderate to strong ability to rule-in the diagnosis and a moderate ability to rule out the diagnosis of foraminal stenosis when using a threshold of 75% improvement in radicular symptoms post-SNRB. Further studies evaluating the result of this physical examination test in conjunction with severity of imaging findings are warranted.

Traditional herbal medicine (THM) is an important part of the traditional Chinese medicine culture. Due to its high medicinal potential, it should not only serve for the Chinese people's medical use, but also contribute to the world medicine, THM for the international market must be standardized and large-scale, and produced according to the “Good Agriculture Practice” (GAP). The quality of THM directly affects the patient's treatment status and safety of use. Therefore, the quality assurance of THM runs through the entire process of research and development, production and clinical practice. The standardized production and cultivation of THM is the starting point of the THM industry chain and plays a decisive role in the economic development of the THM industry. This article summarizes the development history, limitations and future development of GAP, and clarifies the opportunities for THM in the rapid development of the international and domestic Chinese medicine industry. In addition, analyzing the deficiencies that were existing in the former GAP implementation process and by suggesting science-based quality measures, it is hoped to stipulate improved GAP guidelines in the future and to lay the foundation for a modern THM international trade.