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TaggedAPTARAFigure TaggedAPTARAEnd238                                                          X.R. Tan et al.



































         Fig. 3. T br and cerebral perfusion under hyperthermia. T br and T re measurements (mean § SD) during pre- and post-intervention MRI scans for (A) EX, (B) PA,
         (C) CL, and (D) CT trials. T br is denoted by solid lines while T re is denoted by dotted lines. (E) Cerebral perfusion changes across the cortical surface in all trials.
         Color scale represents the cluster significance (-log(p)) where 4.00 denotes p < 0.0001, 1.33 denotes p < 0.05; red gradient denotes increased perfusion while blue
         gradient denotes decreased perfusion. Normalized % change in cerebral perfusion across trials in (F) whole brain (restricted to gray matter); (G) precentral
         gyrus, (H) postcentral gyrus, (I) insula, and (J) thalamus. Bars represent the mean, and lines represent the SD. Each symbol represents a value from an individual
         participant (n = 11). Significant difference between trials is denoted by asterisk (* p < 0.05, ** p < 0.01, *** p < 0.001). CL = cooling trial; CT = control trial;
         EX = exertional hyperthermia trial; GM = gray matter; MRI = magnetic resonance imaging; PA = passive hyperthermia trial; T br = brain temperature; T re = rectal
         temperature.TaggedAPTARAEnd


         similarlytoT re . However, in the PA trial (Fig. 3B), post-inter-  intensities (60% + 80% maximal voluntary contraction) with
         vention T br was lower than T re (p < 0.05), with a lower magni-  that of no-task baseline (refer to Supplementary Fig. 1 for
         tude of temperature elevation from baseline (+0.9˚C § 0.5˚C vs.  combined analysis from all intensities). Voxelwise task-acti-
                                                               vated brain clusters from data at all timepoints are shown in
         +2.1˚C § 0.2˚C). In CT trials (Fig. 3D), post-intervention T br
                                                               Fig. 4A. All activated clusters are expected regions of interest
         remained consistently higher than resting T re (p < 0.01).TaggedAPTARAEnd
                                                               related to task except for left lateral-orbitofrontal and right
                                                               medial-orbitofrontal clusters, which could be a consequence of
         TaggedAPTARAH23.3. Cerebral blood flowTaggedAPTARAEnd
            TaggedAPTARAPReductions in cerebral perfusion (p < 0.0001) were observed  slight motion during plantarflexion. However, we found no
         across parietal and frontal areas in EX trials (Fig. 3E). These  significant differences in movement between baseline and post
                                                               scans when assessed from both the maximum displacement
         deficits appeared greater and more distributed across cortical
                                                               and the rate of change of displacement. For the left hemi-
         areas in PA trials. In contrast, the reduced cerebral perfusion in
                                                               spheric motor-related cluster (precentral gyrus; Fig. 4B), the
         CL and CT trials was confined to smaller cortical regions, and it
                                                               relative percent BOLD values in the post scans were lower
         was less pronounced in CT trials (Fig. 3E). Global gray matter
                                                               than baseline for EX (p = 0.009) and PA (p = 0.006) but not for
         perfusion was reduced in the post scans of PA trials as compared
                                                               CL trials. The left paracentral cluster (Fig. 4C) presented a
         with baseline (p = 0.016; Fig. 3F). Regional perfusion in precen-
                                                               lower relative percent BOLD value in the post scans for EX
         tral and postcentral gyri were lowered in the post scans of PA,
                                                               (p = 0.014). A precentral gyrus cluster was observed in the
         but not for CT and CL trials (precentral: p = 0.009; postcentral:
                                                               right hemisphere (ipsilateral to leg movement; Fig. 4F) with
         p = 0.035; Fig. 3G and 3H). No differences in perfusion were
                                                               relative percent BOLD values reduced from baseline to post
         observed for subcortical regions (insula and thalamus) across
                                                               scans for both EX (p = 0.0009) and PA (p = 0.026).TaggedAPTARAEnd
         scans (Fig. 3I and 3J).TaggedAPTARAEnd
                                                                  TaggedAPTARAPOther clusters observed to exhibit significant changes
                                                               included the left superior-frontal and right superior-parietal
         TaggedAPTARAH23.4. Cortical motor activityTaggedAPTARAEnd
                                                               clusters. Similar to other clusters, the left hemispheric supe-
            TaggedAPTARAPMotor task-related BOLD analysis was used to compare  rior-frontal cluster (Fig. 4D) showed a lower relative percent
         functional brain activity during plantarflexion at higher  BOLD value in the post scan for PA trial (p = 0.020), and the
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