I don't know how this all actually works, so let me ask a few questions.

1. I assume that in order to do this, the server hosts will all need to run -txt -direct and have a data folder. Is this just the data folder in their D2 directory?

2. Alternatively, does it mean that all server hosts need to download a modified patch_d2.mpq?

Assuming that a new patch_d2.mpq isn't required, what exactly can be altered without screwing things up?

- Strings? Can we fix the "Evil Force" unique items?
- item sizes? Can we make the soulstones 2 pixels?
- I assume graphics can be tweaked
- item variables? Could -10% to Enemy Poison Resistance be removed from the unique javalins for example? Or will that break existing items?
- what about socketables? If we reduced -poison resists on emeralds, would that cause display errors for users?

Just want to get an idea of what is possible here.

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People who live in cinder block houses can throw whatever they want.

No, item names are read from your client, need small update clientside
In theory yes, but need to check first - you can corrupt existing chars, when someone will try to join he will get message invalid item in inventory(aka they will require more space so will merge with other items).To test it we can let someone have all existing shards(single player char) and join someones game with shard 1x2 changed(open battle net or tcp/ip)
clientside only.
Existing items will be still there making them way more superior, but you can alter all uniqs and nothing will happen - see Gris caddy bug last ladder, even near reset ppl still got old version
Yes, ppl without clientside updates will still see -12 but in fact they will be, for example - 8, confusing but not game breaking AS passive pierce doesn't work on immunes.
Skill changes altering gain values (skeles, hp gain on them, all damage), for example ppl without update still had 10 skeles on 1 lvl soft point summ skeles but could cast only one. Worth of testing is CE as client may still prevent you casting it(button may be red), adding delay to skill is easier than removing it I'm afraid.
Other changes that can be serverside
all sets
all uniqs
monstats - it may be confusing tho, for example if monster has 60phys res on my game but 40% on server If he spawns stoneskin he might be still immune on my display. Worth checking.

ok, so it sounds like even the ones that can change would be buggy. Was kinda worried about that.

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People who live in cinder block houses can throw whatever they want.