Comparing Electron Energetics and UV Brightness in Jupiter's Northern Polar Region During Juno Perijove 5.

We compare electron and UV observations mapping to the same location in Jupiter's northern polar region, poleward of the main aurora, during Juno perijove 5. Simultaneous peaks in UV brightness and electron energy flux are identified when observations map to the same location at the same time. The downward energy flux during these simultaneous observations was not sufficient to generate the observed UV brightness; the upward energy flux was. We propose that the primary acceleration region is below Juno's altitude, from which the more intense upward electrons originate. For the complete interval, the UV brightness peaked at ~240 kilorayleigh (kR); the downward and upward energy fluxes peaked at 60 and 700 mW/m2, respectively. Increased downward energy fluxes are associated with increased contributions from tens of keV electrons. These observations provide evidence that bidirectional electron beams with broad energy distributions can produce tens to hundreds of kilorayleigh polar UV emissions.

Interaction with St. John's wort due to exposure with blackcurrant aroma? How not to present a case report of an adverse event.

Background: Adverse events case reports are important for signal generation in pharmacovigilance. They require a thorough collation of the facts, otherwise they may lead to erroneous conclusions which may conceal other treatment-related causes of the observation. Methods: We describe a case report from the literature that arrives at an erroneous conclusion merely from taking insufficient care when collating and interpreting the facts: The authors of the case report confused blackcurrant (Ribes nigrum) with St. John's wort preparation (Hypericum perforatum) and erroneously assumed that the intake of a herbal preparation was responsible for a drop in serum levels of everolimus. Results: The clinical observations in this case report may actually reflect a potentially lethal situation emerging from the prescribed medication everolimus. St. John's wort preparations rich in hyperforin do in fact reproducibly lead to the decrease of blood levels of medications metabolized through cytochrome P450 subtype 3A4. However, a case report requires more care than just ascribing the blame to something seemingly well-known. Conclusion: The readers of this report might have profited more from the description of the risks of treating graft-versus-host disease with everolimus, and the action to be taken in case of potentially severe adverse reactions to everolimus.

Diagnostic guidelines for the histological particle algorithm in the periprosthetic neo-synovial tissue.

BACKGROUND: The identification of implant wear particles and non-implant related particles and the characterization of the inflammatory responses in the periprosthetic neo-synovial membrane, bone, and the synovial-like interface membrane (SLIM) play an important role for the evaluation of clinical outcome, correlation with radiological and implant retrieval studies, and understanding of the biological pathways contributing to implant failures in joint arthroplasty. The purpose of this study is to present a comprehensive histological particle algorithm (HPA) as a practical guide to particle identification at routine light microscopy examination. METHODS: The cases used for particle analysis were selected retrospectively from the archives of two institutions and were representative of the implant wear and non-implant related particle spectrum. All particle categories were described according to their size, shape, colour and properties observed at light microscopy, under polarized light, and after histochemical stains when necessary. A unified range of particle size, defined as a measure of length only, is proposed for the wear particles with five classes for polyethylene (PE) particles and four classes for conventional and corrosion metallic particles and ceramic particles. RESULTS: All implant wear and non-implant related particles were described and illustrated in detail by category. A particle scoring system for the periprosthetic tissue/SLIM is proposed as follows: 1) Wear particle identification at light microscopy with a two-step analysis at low (× 25, × 40, and × 100) and high magnification (× 200 and × 400); 2) Identification of the predominant wear particle type with size determination; 3) The presence of non-implant related endogenous and/or foreign particles. A guide for a comprehensive pathology report is also provided with sections for macroscopic and microscopic description, and diagnosis. CONCLUSIONS: The HPA should be considered a standard for the histological analysis of periprosthetic neo-synovial membrane, bone, and SLIM. It provides a basic, standardized tool for the identification of implant wear and non-implant related particles at routine light microscopy examination and aims at reducing intra-observer and inter-observer variability to provide a common platform for multicentric implant retrieval/radiological/histological studies and valuable data for the risk assessment of implant performance for regional and national implant registries and government agencies.

[Compatibility and allergies of osteosynthesis materials]. / Verträglichkeit und Allergie von Osteosynthesematerialien.

Metal implants for osteosynthesis are nowadays standard in orthopedic and trauma surgery. Steel implants, especially cerclages, bands and wires, can show more corrosion due to friction and lead to encapsulation in connective tissue with fluid borders even without loosening. Corrosion and fluid borders are potentially more susceptible to incompatibility and infections. Titanium implants have the advantage of better allergic compatibility. Problems may occur in material removal, especially with titanium implants because material fractures occur more frequently. Particularly with fixed angle constructions, the blocking of titanium-titanium bonding and/or screws in bone can occur by adhesion and ingrowth. Apart from single case reports there is no evidence that modern steel implants cause more allergic reactions than titanium; therefore, in the treatment by osteosynthesis the stability, risk of loosening, manifestation of allergies and the possibility of material removal must always be considered.

AGXT and ERCC2 polymorphisms are associated with clinical outcome in metastatic colorectal cancer patients treated with 5-FU/oxaliplatin.

The objective of the study was to investigate whether specific single nucleotide polymorphisms (SNPs) with influence on drug transport, biotransformation and repair mechanisms are associated with treatment outcome and toxicity in metastatic colorectal cancer (mCRC). We genotyped blood samples from 519 mCRC patients treated with first-line 5-fluorouracil and oxaliplatin +/- cetuximab for 17 SNPs in 10 genes involved in membrane transport (ABCC1 and ABCC2), drug biotransformation (GSTP1 and AGXT) and DNA repair (ERCC1, ERCC2, XRCC1, XRCC3, XPG and MSH6). The AGXT-rs34116584 and the ERCC2-rs238406 polymorphisms were significantly associated with progression-free survival (P=0.002 and P=0.001, respectively). Associations between 18 toxicity variables and SNPs were identified, although none were significant after Bonferroni correction for multiple comparisons. The study identified SNPs of potential use as markers of clinical outcome in oxaliplatin-treated mCRC patients. If validated in other studies, they could improve the selection of therapy in mCRC.

[Adverse reactions to metal orthopedic implants after knee arthroplasty]. / Adverse Reaktionen gegenüber orthopädisch-chirurgischen Metallimplantaten nach Kniegelenkersatz.

Based on several clinical examples, the range of adverse or hypersensitive reactions to metal implants especially after total knee replacement are presented. In general, we found the patients to generally be women who present with pain, swelling, and local or generalized eczema. Some also present with early aseptic loosening mainly in the first 4 years after implantation. For these patients, a detailed allergy-specific history should be taken and a patch test should be performed; if necessary, blood ion levels should be evaluated to exclude cobaltism. Before revision surgery and exchange of the implant we always perform arthroscopic inspection to obtain biopsies for microbiology and histopathology. Using the Consensus Classification a good evaluation for planning revision with the different implant options is possible.

[Supramacroparticulate polyethylene in inflammation of synovial-like interface membranes: Characterization and suggested nomenclature]. / Supramakropartikuläres Polyethylen bei Entzündungen periprothetischer Membranen: Charakterisierung und Nomenklaturvorschlag.

BACKGROUND: The identification of particles of prosthesis material components in the histopathological diagnosis of synovialitis is of great importance in the evaluation of implant failure. MATERIALS AND METHODS: In histopathological particle algorithms, polyethylene (PE) particles with a maximum length of less than 100 µm are designated with the term macroparticles; however, a systematic investigation and characterization are lacking. RESULTS: In SLIM knee specimens (n = 24) a minimum value of 210 µm and a maximum value of 2100 µm were measured; the mathematical mean length varied between 235 µm and 1416 µm. In SLIM hip specimens (n = 11) the minimum value was 290 µm and the maximum value was 1806 µm; the mean length varied between 353 and 1726 µm. Because of this conspicuous size, and to distinguish from PE macroparticles, the designation PE supra-macroparticulate is suggested. This new terminology acknowledges the fact that these PE particles are visible under magnification (e.g., × 12.5) and also macroscopically. The particles were also indirectly proven as there were completely separate and optically clear, column-shaped cavities corresponding to the shape of the PE particles (PE vacuoles). The life of the prosthesis is highly variable at between 12 and 300 months. In all cases loosening of the prosthesis, misalignment of the PE components, and/or damage to the PE inlay occurred. CONCLUSION: The cause and existence of these supra-macroparticulate PE particles (more than 100 µm) is still unclear. A mechanical malfunction seems probable and should be discussed. In prostheses with short lives the proof of supra-macroparticulate PE in SLIM could be a sign of an early mechanical problem. In the wider histopathological particle algorithm supra-macroparticulate PE was considered to fall in the category of macroparticles and should be considered in the histopathological diagnosis of implant failure.

Role of Sphingosine-1-Phosphate in Transplant Vasculopathy Evoked by Anti-HLA Antibody.

Transplant vasculopathy (TV) represents the main cause of late graft failure and limits the long-term success of organ transplantation. Cellular and humoral immune responses contribute to the pathogenesis of the concentric and diffuse intimal hyperplasia of arteries of the grafted organ. We recently reported that the mitogenic signaling, evoked in human vascular smooth muscle cells (hmSMC) by the anti-HLA class I monoclonal antibody W6/32, implicates neutral sphingomyelinase-2, suggesting a role for sphingolipids in intimal hyperplasia of TV. Here, we investigated whether the mitogenic sphingolipid, sphingosine-1-phosphate (S1P), is involved in intimal hyperplasia elicited by W6/32. Studies were done on cultured hmSMC and on an in vivo model of TV, consisting of human mesenteric arteries grafted into SCID/beige mice, injected weekly with W6/32. hmSMC migration and DNA synthesis elicited by W6/32 were inhibited by the sphingosine kinase-1 (SK1) inhibitor dimethylsphingosine, the anti-S1P antibody Sphingomab and the S1PR1/R3 inhibitor VPC23019. W6/32 stimulated SK1 activity, while siRNA silencing SK1, S1PR1 and S1PR3 inhibited hmSMC migration. In vivo, Sphingomab significantly reduced the intimal thickening induced by W6/32. These data emphasize the role of S1P in intimal hyperplasia elicited by the humoral immune response, and open perspectives for preventing TV with S1P inhibitors.

Asymmetries observed in Saturn's magnetopause geometry.

For over 10 years, the Cassini spacecraft has patrolled Saturn's magnetosphere and observed its magnetopause boundary over a wide range of prevailing solar wind and interior plasma conditions. We now have data that enable us to resolve a significant dawn-dusk asymmetry and find that the magnetosphere extends farther from the planet on the dawnside of the planet by 7 ± 1%. In addition, an opposing dawn-dusk asymmetry in the suprathermal plasma pressure adjacent to the magnetopause has been observed. This probably acts to reduce the size asymmetry and may explain the discrepancy between the degree of asymmetry found here and a similar asymmetry found by Kivelson and Jia (2014) using MHD simulations. Finally, these observations sample a wide range of season, allowing the "intrinsic" polar flattening (14 ± 1%) caused by the magnetodisc to be separated from the seasonally induced north-south asymmetry in the magnetopause shape found theoretically (5 ± 1% when the planet's magnetic dipole is tilted away from the Sun by 10-17°).

Simultaneous saccharification and fermentation of solid household waste following mild pretreatment using a mix of hydrolytic enzymes in combination with Saccharomyces cerevisiae.

Ethanol production from low severity pretreated (85 °C, 1 h) solid household waste was studied using simultaneous saccharification and fermentation (SSF). The aim of the study was to examine typical composition of the organic fraction of municipal solid waste (OFMSW) and to develop a simple method for simultaneous liquefaction and biofuels production. A model waste was prepared based on the composition of the organic waste in Masdar City. Chemical analysis of the OFMSW showed that it contained 37 % total solids with up to 57 g glucan/100 g total solid (TS). Hydrolysis of the wet OFMSW was carried out using a mix of hydrolytic enzymes: amylase, cellulase, protease, lipase, hemicellulase, and pectate lyase. The enzymatic hydrolysis using this enzyme mix was studied using different dilutions of the OFMSW at different enzyme loadings. This study has demonstrated that SSF of low severity pretreated OFMSW can be carried out using Saccharomyces cerevisiae without dilution (addition of water), and liquefaction of the undiluted OFMSW can be achieved in less than 24 h of hydrolysis. Also, SSF of the pretreated waste can be carried out with very low enzyme loading (10 % of the company recommended dosage)-0.1 % cellulase, 0.1 % amylase, 0.02 % protease, 0.02 % hemicellulase, 0.02 % lipase, and 0.02 % pectate lyase (w/w per TS) following mild heat pretreatment conditions of 85 °C for 1 h.

Associations between functional polymorphisms in the NFκB signaling pathway and response to anti-TNF treatment in Danish patients with inflammatory bowel disease.

Antitumor necrosis factor-α (TNF-α) is used for treatment of severe cases of inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). However, one-third of the patients do not respond to the treatment. Genetic markers may predict individual response to anti-TNF therapy. Using a candidate gene approach, 39 mainly functional single nucleotide polymorphisms (SNPs) in 26 genes regulating inflammation were assessed in 738 prior anti-TNF-naive Danish patients with IBD. The results were analyzed using logistic regression (crude and adjusted for age, gender and smoking status). Nineteen functional polymorphisms that alter the NFκB-mediated inflammatory response (TLR2 (rs3804099, rs11938228, rs1816702, rs4696480), TLR4 (rs5030728, rs1554973), TLR9 (rs187084, rs352139), LY96 (MD-2) (rs11465996), CD14 (rs2569190), MAP3K14 (NIK) (rs7222094)), TNF-α signaling (TNFA (TNF-α) (rs361525), TNFRSF1A (TNFR1) (rs4149570), TNFAIP3(A20) (rs6927172)) and other cytokines regulated by NFκB (IL1B (rs4848306), IL1RN (rs4251961), IL6 (rs10499563), IL17A (rs2275913), IFNG (rs2430561)) were associated with response to anti-TNF therapy among patients with CD, UC or both CD and UC (P ⩽ 0.05). In conclusion, the results suggest that polymorphisms in genes involved in activating NFκB through the Toll-like receptor (TLR) pathways, genes regulating TNF-α signaling and cytokines regulated by NFκB are important predictors for the response to anti-TNF therapy among patients with IBD. Genetically strong TNF-mediated inflammatory response was associated with beneficial response. In addition, the cytokines IL-1ß, IL-6 and IFN-γ may be potential targets for treating patients with IBD who do not respond to anti-TNF therapy. These findings should be examined in independent cohorts before these results are applied in a clinical setting.

Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study.

OBJECTIVE: To investigate whether the relative size of intraluminal thrombus (ILT) in abdominal aortic aneurysms (AAAs) is associated with AAA growth. METHODS: This large observational study was based on a randomised population-based screening trial. Six hundred and fifteen AAAs were diagnosed in men aged 65-74 years. The relative cross-sectional area covered by the mural thrombus was estimated by a semiautomatic method using ultrasound equipment to measure the area of the ellipses, and adapting the inner ellipse (IA) to the luminal border of the thrombus and the outer ellipse to the area inside the media border (OA). The relative thrombus area was then calculated as ((OA-IA)/OU) × 100%. Four hundred and sixteen of the patients with AAA were eligible for analysis. RESULTS: The mean size of the AAA was 40.6 mm, and the mean observation time was 1.78 years. In the group with AAAs measuring 30-34 mm, 42% had ILT, with a mean relative size of 12% of the outer area. In the group with AAAs measuring >64 mm, the presence of ILT increased to 100%, with a mean relative size of 70% of the outer area. Univariate analysis showed relative ILT size, aortic diameter, smoking history, and diastolic blood pressure were significantly positively associated with growth rate, while the presence of diabetes mellitus was significantly negatively associated with growth rate. The relative ILT size remained significantly positively associated with the growth rate after a multivariate linear regression adjusting for potential confounders. CONCLUSION: These findings suggest that ILT may play a part in the progression of AAAs.

Cusp observation at Saturn's high-latitude magnetosphere by the Cassini spacecraft.

We report on the first analysis of magnetospheric cusp observations at Saturn by multiple in situ instruments onboard the Cassini spacecraft. Using this we infer the process of reconnection was occurring at Saturn's magnetopause. This agrees with remote observations that showed the associated auroral signatures of reconnection. Cassini crossed the northern cusp around noon local time along a poleward trajectory. The spacecraft observed ion energy-latitude dispersions-a characteristic signature of the terrestrial cusp. This ion dispersion is "stepped," which shows that the reconnection is pulsed. The ion energy-pitch angle dispersions suggest that the field-aligned distance from the cusp to the reconnection site varies between ∼27 and 51 RS . An intensification of lower frequencies of the Saturn kilometric radiation emissions suggests the prior arrival of a solar wind shock front, compressing the magnetosphere and providing more favorable conditions for magnetopause reconnection. KEY POINTS: We observe evidence for reconnection in the cusp plasma at SaturnWe present evidence that the reconnection process can be pulsed at SaturnSaturn's cusp shows similar characteristics to the terrestrial cusp.

Fixation of the shorter cementless GTS™ stem: biomechanical comparison between a conventional and an innovative implant design.

INTRODUCTION: Conventional cementless total hip arthroplasty already shows very good clinical results. Nevertheless, implant revision is often accompanied by massive bone loss. The new shorter GTS™ stem has been introduced to conserve femoral bone stock. However, no long-term clinical results were available for this implant. A biomechanical comparison of the GTS™ stem with the clinically well-established CLS(®) stem was therefore preformed to investigate the targeted stem philosophy. MATERIALS AND METHODS: Four GTS™ stems and four CLS(®) stems were implanted in a standardized manner in eight synthetic femurs. A high-precision measuring device was used to determine micromotions of the stem and bone during different load applications. Calculation of relative micromotions at the bone-implant interface allowed the rotational implant stability and the bending behavior of the stem to be determined. RESULTS: Lowest relative micromotions were detected near the lesser trochanter within the proximal part of both stems. Maximum relative micromotions were measured near the distal tip of the stems, indicating a proximal fixation of both stems. For the varus-valgus-torque application, a comparable stem bending behavior was shown for both stems. CONCLUSION: Both stems seem to provide a comparable and adequate primary stability. The shortened GTS™ design has a comparable rotational stability and bone-implant flexibility compared to a conventional stem. This study demonstrates that the CLS(®) stem and the GTS™ stem exhibit similar biomechanical behavior. However, a clinical confirmation of these experimental results is still required.

[Histopathological particle algorithm. Particle identification in the synovia and the SLIM]. / Histopathologischer Partikelalgorithmus. Partikelidentifikation in der Synovialis und in der SLIM.

BACKGROUND: In the histopathological diagnostics of synovitis and the synovium-like interface membrane (SLIM) the identification of crystals and crystal-like deposits and the associated inflammatory reactions play an important role. The multitude of endogenous crystals, the range of implant materials and material combinations, and the variability in the formation process of different particles explain the high morphological particle heterogeneity which complicates the diagnostic identification of diagnostic particles. STUDY DESIGN AND METHODS: A simple histopathological particle algorithm has been designed which allows methodological particle identification based on (1) conventional transmitted light microscopy with a guide to particle size, shape and color, (2) optical polarization criteria and (3) enzyme histochemical properties (oil red staining and Prussian blue reaction). These methods, the importance for particle identification and the differential diagnostics from non-prosthetic materials are summarized in the so-called histopathological particle algorithm. RESULTS: A total of 35 cases of synovitis and SLIM were analyzed and validated according to these criteria. Based on these criteria and a dichotomous differentiation the complete spectrum of particles in the SLIM and synovia can be defined histopathologically. CONCLUSION: For histopathological diagnosis a particle score for synovitis and SLIM is recommended to evaluate (1) the predominant type of prothetic wear debris with differentiation between microparticles, and macroparticles, (2) the presence of non-prosthesis material particles and (3) the quantification of particle-association necrosis and lymphocytosis. An open, continuously updated web-based particle algorithm would be helpful to address the issue of particle heterogeneity and include all new particle materials generated in a rapidly changing field.

[Current design and cement mantle thickness in hip arthroplasty : Theory and analysis of register data]. / Aktuelles Design und Zementmanteldicke in der Hüftendoprothetik : Theorie und Analyse der Registerdaten.

BACKGROUND: In this article, an overview and comparison of the most commonly used cemented hip stems, grouped into different stem types and cement mantle thickness, is given to see which combination performs well. METHODOLOGY: Revision rates of cemented stem types were categorized from the Endoprosthesis Register-Germany, and 3­ and 5­year revision rates were reported and analyzed. For the research, the focus was on the Exeter, C­Stem, MS-30, Excia, Bicontact, Charnley, Müller straight stem, Twinsys, Corail, Avenir, Quadra, and the Lubinus SP II stems. An important aspect was which stem is preferred to be implanted and which cementing technique is used with regard to the planned cement mantle thickness. In order to identify a trend in cemented hip arthroplasty, data from the Danish, Swedish, Norwegian, Swiss, New Zealand, English and Australian arthroplasty registers were also compared. RESULTS AND CONCLUSION: Most countries use cemented prostheses according to the taper slip principle (Exeter, MS30, C­Stem etc) or the composite beam (Charnley, Excia, Bicontact), which are implanted with a cement mantle thickness of 2-4 mm. However, a trend has emerged in Germany and Switzerland towards the line-to-line technique, with a planned cement mantle thickness of 1 mm (Twinsys, Corail, Avenir, Quadra), following the principle of the Müller straight stem prosthesis and the Kerboul-Charnley prosthesis, even though these are postulated to be "French paradoxes" in themselves. In the EPRD 5­year results, the newer line-to-line prostheses seem to perform slightly worse. The best results are achieved by the "MS 30" in Germany and the "Exeter" in England. These are polished straight stems with centralizer and subsidence space at the apex with a 2-4 mm cement mantle in good cementing technique.

[Use of allergy implants in Germany: results of a survey]. / Verwendung von Allergieimplantaten in Deutschland: Ergebnisse einer Umfrage.

In a representative survey among members of the working group for joint replacement (AE) in Germany (86.7% response) it was found that 0.6% of patients with total knee arthroplasty (TKA) and 1.2% of patients with total hip arthroplasty (THA) may have a problem due to hypersensitivity to nickel or cobalt after implantation. Only one third of them may need revision surgery. Although patients with hypersensitivity are rare 84% of surgeons would prefer to use a specially coated allergy implant for knee arthroplasty patients. However, no long term results and few data on the topic of allergies and joint arthroplasty are available for these implants so that this has to be critically discussed with patients. Before a revision is performed it is recommended to perform knee arthroscopy to obtain tissue for microbiological and histopathological investigations. The second part of this questionnaire will look at the special question of how to deal with allergy patients based on constructed case examples.

[Allergy diagnostics in suspected metal implant intolerance]. / Allergiediagnostik bei Verdacht auf Metallimplantatunverträglichkeit.

Allergy diagnostics may be requested before implantation or in cases of complications by implants. Preimplant allergy testing by patch test should only be done in patients with a reported history of potential allergies to metal or bone cement components and prophetic prophylactic testing should not be done. For baseline diagnostics of suspected implant allergy a patch test with the standard series (containing Ni, Co and Cr preparations) and with bone cement components and peri-implant histology should be performed after exclusion of frequent complication elicitors (in particular low grade infections). This can show a peri-implant T-lymphocyte dominated inflammation. Additional information on a scientific level is given by the lymphocyte transformation test (LTT) assessing metal sensitivity and by peri-implant molecular cytokine profiling giving the inflammatory pattern.

[Different symptoms in patients with prostheses with metal-metal bearings]. / Unterschiedliche Erscheinungsbilder bei Patienten mit Metall-Metall-Gleitpaarungs-Prothesen.

Based on several clinical case examples, this article demonstrates the different symptoms and complications in patients fitted with prostheses with metal-on-metal (MoM) bearings. We recommend an annual clinical control for patients with MoM prostheses with a prosthesis head size of 36 mm or larger. In patients who have problems tests should be carried out to measure the metal ion levels of cobalt and chromium and the metal artifact-reduced sequence by magnetic resonance imaging (MRI) or if this is not possible an ultrasound investigation. The clinical investigations should specifically target asymptomatic local swellings or hardened sites and patients should be questioned on problems with general hypersensitivity reactions (skin rash), cardiomyopathy, neurological changes including sensory changes, renal function impairment and thyroid dysfunction.

[Histopathological differential diagnostics in context of joint implant allergic reactions]. / Histopathologische Differenzialdiagnostik bei gelenkimplantatallergischen Fragestellungen.

Total joint replacement has greatly increased over the last decades and so have endoprothesis-associated pathologies. European studies have shown a 10-year durability varying from 88% to 95%. By means of histopathology different pathogenetic synovial-like interface membrane (SLIM) patterns that lead to reduction of implant durability can be discerned, such as periprosthetic particles, bacterial infections and arthrofibrosis. Subsequently, SLIM types have been determined in a revised consensus classification including particle-induced type (type I) so-called non-septic loosening, infection type (type II) so-called septic loosening, combination type (type III) of bacterial and particle-induced types, indifferent type with mechanical and functional disorders (type IV), osseus pathologies (type V), arthrofibrotic type (type VI, endoprosthesis-associated arthrofibrosis) and allergic/immunological/toxic reactions to prosthesis material (type VII). Particles are characterized histopathologically according to the Krenn particle algorithm. In cases of severe lymphocyte/macrophage infiltration, necrosis, abrasion particle detection and granuloma formation, a toxic or allergic reaction to implant material should be considered. As a direct abrasion particle-induced toxicity cannot be differentiated from a particle-induced allergic type VII reaction to implant material, the histopathological diagnosis of toxic reaction to implant material or allergic reaction to implant material should be made with caution and only in association with immunological, allergic and clinical data. It is recommended that tissue samples should be arthroscopically taken from different regions: close to the prosthesis, distant from the prosthesis and from bone tissue. The pathologist should be given information concerning clinical, allergological and microbiological data.