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TaggedAPTARAFigure TaggedAPTARAEndHeat exposure on brain activity and cognitive function              239























           Fig. 4. Functional activation (BOLD) during plantarflexion motor task. (A) Task-related activation (60% + 80% MVC vs. no-task). Activated brain clusters include
           precentral gyrus, superior frontal gyrus, paracentral lobule, medial orbitofrontal cortex, lateral orbitofrontal cortex, and superior parietal gyrus. Color scale repre-
           sents the cluster significance (-log(p)) where 4.00 denotes p < 0.0001, 1.33 denotes p < 0.05; red gradient denotes increased activity while blue gradient denotes
           decreased activity. Normalized percent BOLD change in baseline (S1) and post-intervention (S2) scans in LH: (B) precentral, (C) paracentral, (D) superior frontal,
           and (E) lateral orbitofrontal clusters; in RH: (F) precentral and (G) superior parietal clusters. 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). BOLD = blood oxygenation level-dependent;
           CL = cooling trial; EX = exertional hyperthermia trial; LH = left hemisphere; MVC = maximal voluntary contraction; PA = passive hyperthermia trial; RH = right
           hemisphere.TaggedAPTARAEnd

           right hemisphere superior-parietal cluster similarly reduced  congruent and incongruent stimuli across trials. To investigate
           relative percent BOLD values in the post scans for both EX  the neural changes underlying the lower task accuracy in PA
           (p = 0.003) and PA (p = 0.012) trials (Fig. 4G). While no  trials, paired voxelwise comparison was performed between
           significant changes were seen in the right medial-orbitofrontal  the post scans of PA and CT. For task-related activation, PA
           cluster, the left hemispheric lateral-orbitofrontal cluster  trials showed greater activity in the precentral gyrus and
           (Fig. 4E) showed lower relative percent BOLD values than the  depressed activities in superior-temporal and superior-parietal
                                                                 gyri (Fig. 6C). In terms of specific comparison between
           baseline scans (p < 0.05).TaggedAPTARAEnd
                                                                 congruent and incongruent stimuli, lower BOLD activity was
                                                                 found in the left lateral occipital cortex in PA trials (Fig. 6D).TaggedAPTARAEnd
           TaggedAPTARAH23.5. Executive function and associated brain activityTaggedAPTARAEnd
             TaggedAPTARAPFaster reaction times were observed in the post scans of
                                                                 TaggedAPTARAH14. DiscussionTaggedAPTARAEnd
           both EX and CL trials compared to baseline (EX: p = 0.045;
           CL: p = 0.048; Fig. 5B), though a reduction in response accu-  TaggedAPTARAPTo date, our understanding of the relationship between T br
           racy was noted exclusively in the post scans of PA trials  and systemic body temperature is largely informed by clinical
                                                                                                      2931
                                                                 studies examining patients with brain injuries.  In healthy
           (p = 0.017) (Fig. 5A).TaggedAPTARAEnd
             TaggedAPTARAPThe reduced task accuracy could be attributed to either  individuals, T br is traditionally assessed with indirect measure-
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           attentional deficit or impaired conflicting resolving ability,  ments such as the tympanic membrane temperature.
           thus the responses to congruent or incongruent stimuli were  However, the validity of this method has been challenged
           analyzed independently (refer to Supplementary Table 1 for  because tympanic temperature can be influenced by ambient
           overall Stroop interference scores). The % change in accuracy  air temperature and skin temperature of the head. 33  In our
                                                                      1
           for congruent stimuli was similar across trials (Fig. 5C).  study, H MRS thermometry allowed for non-invasive T br esti-
           However, the % change in accuracy for incongruent stimuli  mation by measuring the chemical shift of water molecules,
           (Fig. 5E) tended to be lower in PA trials (p = 0.083), which  whose frequency shifts linearly with temperature 34  in refer-
           could account for the overall lowered response accuracy. The  ence to NAA with a temperature-independent chemical shift.
           reaction times, for both congruent and incongruent stimuli,  This enabled us to reliably assess T br in hyperthermic volun-
           were faster in the post scans of EX, CL, and PA trials (p <  teers while relating it to T re in real time.TaggedAPTARAEnd
                                                                   TaggedAPTARAPThe resting T br was observed to be consistently higher than
           0.05) (Fig. 5D and 5F).TaggedAPTARAEnd
             TaggedAPTARAPTo assess changes in brain function, task-activated BOLD  T re , which corroborates the findings of a recent study comparing
           clusters were extracted (Fig. 6A). No significant changes were  resting T br to oral temperature in healthy humans. 35  Ahigher
           found for EX or PA trials relative to baseline; however,  resting T br could be attributed to the relatively greater metabolic
           increased activities in left and right superior-temporal sulci  rate of the brain, which accounts for 20% of our body oxygen
           were observed in CL trials (left: p = 0.014; right: p = 0.032;  consumption at rest despite representing only »2% of body
           Fig. 6B). No clusters were found when comparing between  mass. Brain metabolism has been shown to be remarkably
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